"I Go To a Very Good Dentist"

At Thanksgiving dinner my friend's daughter in law told me that 'she goes to a very good dentist in Manhattan and that it only cost her $10.'

You can probably guess my immediate and shall we say 'indelicate' response to this very bright young lady who lacks the ability to judge excellence. I told this young lady that she did not go to a very good dentist who participated with her insurance and where she had to pay $10.

Let's think of this in terms of houses or cars which are things that we buy and can relatively understand. 

If someone pays $11,000 for a new car do you think that they have a right to expect that they have purchased a Lexus? Or if someone buys a fixer upper for $25,000 does anyone think that have purchased a magnificent home in Beverly Hills?

About every 18-24 months I review the finances of operating a private dental practice and I guess this is as good a time to repeat this:

The average dental office has an overhead of 70% which means that some overhead (rent, staff, supplies, lab fees, insurance, office taxes, donations  and utilities) are slightly below or above 70%. The government: federal, state, local, medicare, social security and school taxes amount to 50% of the remaining 30%. If you have done your math up to this point, it means that I get to take home and spend 15 cents out of every dollar that I produce. Is this a lot???? I don't think so.

Many dentists who participate with insurance companies give the insurance company a 20-30% discount from their usual fees.

Uh Oh….How does a dentist 'give away' 30% when overhead is 70% and they would make no income.

Easy:

…cleaning appointments will be 15-30 minutes instead of 45-60 minutes

…instead of using resin that is fabulous and costs $100 to fix front teeth, dentists will use a $50 resin

…instead of using a quality American laboratory to make crowns, they will use a Chinese lab that charges very little but may 'accidentally' use a little lead in the crown

…spend 10-15 minutes fixing a tooth instead of an hour

…constantly hire and fire staff so that no one knows your name when you enter the office.

Does this make sense? 

It is very challenging to participate with insurance companies and try to pursue excellence.

In the final analysis, if you pay a little for something, then your wisdom and intelligence  must tell you that you are not buying the best but rather the best at the (low) price that you are paying.

I hate talking about this .

Young Dentists Looking to Find Happiness in Excellence

A few weeks ago a young dentist sent me an email through the www.benjaminsmile.com website asking if I gave CE courses (continuing education). I responded to her that I didn't but asked her what she wanted to learn and how did she find me. The young dentist told me that she was Googling cosmetic dentists and my website was among many that came up. She went to many websites and decided that she liked the photos of my patients and she particularly liked my blogs.

At her request, I agreed to meet her on Thanksgiving morning as she was traveling from her home in New Jersey and was going to visit friends in Saranac Lake. She was a delightful young dentist who emigrated from Bangalore, India and went to dental school at NYU dental school. She is hungry to learn more and move to her next level of excellence.

(Aside: It truly amazes me that young dentists are looking for what the dental schools were unable to offer them despite spending four grueling years in school. )

I have agreed to help my friend in the same way that I have helped many young dentists. I offer complete access to me via email or texting very much the same way my mentor Dr. Fred McIntyre did for me. We must give our knowledge and experience  to the next generation of dentists so that they can better take care of you.

Unlike Susan's Aunt Sophie who refused to tell anyone her recipe for Pierogies and thus denied her family and others  the pleasure of eating her delicious food, many older dentists give freely of themselves to our young colleagues….Just the way it is supposed to happen.

In One Day

Today I saw patients who live in Dallas, Texas ; Brooklyn, NY; Manhattan and the state of Virginia.

My Dallas patient finally agreed with my recommendation that I find her an accomplished clinician closer to home because she travels too far to see me after moving from Troy, NY.

The Brooklyn patient was my regular patient until she was 22 years old and moved away after college 12 years ago. She has had the same fillings done and redone several times and finally decided that it was time to return to my office and have treatment when she visits her parents who are long time patients. She commented that it was time to return to the dentist that she can trust.

The Manhattan patient is the daughter of one my colleagues and he was tired of seeing new decay around her recently placed dental work when he took her check up x-rays.

My Virginia patient is a retired Troy detective  and he insists that I continue to be his dentist just as I have been for the past 20 years.

I am always so honored when patients endure great hardships in order to  have treatment in my office.

Think about what people see in our office that they are willing to drive hundreds of miles for their dental care. I must be doing something right after almost 40 years as a dentist.

The Old Guys…This is How We Do It Because This Is How We Have Always Done It #2

A few days ago I informed you about how old guys refuse to change their thinking, techniques or materials and preferring to do things the way we always did them.

The American Board of Obstetrics and Gynecology refused to let OB/GYN specialists see men because that is how we have done things since 1935.

Yesterday, the American Board of OB/GYN reversed itself because of the uproar created by its narrow thinking.

Old men need to get out of the way and let younger generations make decisions that affect their professional lives.

The average age of the leadership of the American Dental Association is between 60 and 70 years old while the average age of a dentist is 46.

This makes no sense.

Thank You

"Wow, can I just tell you again.... THANK YOU!! What a world of difference.  I
feel like my old self. Thank you so much.  I forgot I need to schedule for
you to fix my filling so you will have to put up w me again soon."

                                                                         AND

"I just wanted to say thank you for staying so late to work on me yesterday and for doing such a wonderful job. Sadly, there are few professionals who would have done that. I feel blessed to have found you.

Happy Thanksgiving."

                                                                                                   AND 

"Dr. B. well, you certainly know how to care for your patients! Many

thanks. We'll see you at 11:45."    

It seems like a daily event to receive emails and cards of thanks from grateful patients. Every dentist can drag out 'thank you' cards from their patients so receiving these messages is NOT unusual. What is unusual is the number of messages that I receive and the fact that the comments of appreciation are for the things that I have done for the last almost 4 decades.  I have always seen emergency patients on the day that they call or within 24 hours. And I have always gone to my office after hours or in the middle of the night. 

The reality is that I should be sending my PATIENTS  the 'thank you' notes for traveling 40 miles each way or just for being our patient. It is truly a pleasure to take care of my patients.

Crowns: How to Destroy a Tooth

Those of you who have been my patient for more than 20 years know that I have made every effort to enable you to keep every millimeter of beautiful, healthy tooth structure that I can. Another way of saying this is:

 I will not destroy tooth structure for MY personal, financial gain.

I have been perfecting my techniques to maintain and protect your tooth structure for more than two DECADES and I will challenge any dentist or dental school faculty who says that my techniques do not work or that they put YOU at risk.

The top photograph shows a tooth that had a relatively new porcelain onlay that failed when leakage caused massive tooth decay under the onlay. The nerve of this tooth will probably start to die and will require root canal therapy (Hopefully done by Root Canal Experts) in the relatively near future. My goal in treating this tooth at 6 PM on Wednesday evening was to restore this tooth as conservatively as possible and not further traumatize the nerve by removing additional tooth structure for a crown.

The bottom photo shows my completed direct bonded resin restoration…which your insurance company would call, " just a filling."  (And yes I left some extra bonding agent between my new restoration and the tooth to the left of it…UGGGG…I will remove it on the patient's next visit.)

My restoration is the BEST way to restore this incredibly traumatized tooth regardless of the cost or what other dentists will tell you.

DO NOT let dentists tell you that a crown will strengthen your tooth (unless it is a root canal treated tooth). Crowns WEAKEN teeth by removing the strongest part of a tooth (enamel) and should be treatment  of last resort.

I can tell you that my 401K plan really hates the fact that I do so few crowns on healthy teeth…but that is not YOUR problem.  You hire me to take care of you and place your best interest above my own.

(Note: I did not place the direct bonded fillings on either side of the tooth that I restored.)

The Old Guys…This is How We Do It Because This Is How We Have Always Done It

There is an interesting article in today's New York Times about a board certified OB/GYN in Manhattan who treats men with pre-cancerous anal lesions.The American Board of OB/GYN believes that their members should only treat women even though the EXPERTS in cancer research and treatment of pre-cancerous lesions may be OB/GYN physicians.

The Times contacted the Executive Director of the American Board of OB/GYN, Dr. Larry C. Gilstrap  for his comment and he said:

The specialty of obstetrics and gynecology …was restricted to taking care of women …AND THAT'S THE WAY IT'S BEEN SINCE 1935." (My emphasis added)

My first response to Dr. Gilstrap's comment was : another old guy who wants to keep things the way they were because that's the way we have always done it. I decided to find out how old Dr. Gilstrap is and sure enough he is an old (70+) guy from Texas.

Old guys…politicians, physicians, dentists, lawyers want to keep things the way they were because they are EXPERTS in the way things were and unwilling to learn new things or do things in a new way.

The Dental School at SUNY/Buffalo is another example of the old guys not wanted to learn new things  (i.e. techniques that are more than TEN YEARS OLD)  because they will have to re-educate themselves to become experts and doing things in a new and better way FOR THE BENEFIT OF OUR PATIENTS.

Trust me…I fight with myself everyday so that I don't become an OLD, old guy. I constantly am looking for and studying to find ways so that I can provide the best methods, techniques or materials   to take care of YOU.

I graduated dental school in 1977 and with the exception of using a rubber dam…there is NOTHING that I do today  that I was doing in 1977. You will never hear me say,"because that is the way we did it in 1977."

The Most Common Questions

I have been asked the same questions throughout my career:

1. What are you doing HERE?  (Especially when I was in Cropseyville, NY)
2. Does my insurance cover this?
3. What am I going too when you retire?

No one has asked me about my location since I moved to Saratoga Springs. My move has been good for both me and my patients. Very few of my patients ask me about insurance today because everyone knows that I want to do the best clinical dentistry that I can and insurance usually covers the minimally acceptable treatment.

The third question is the most interesting to me because patients would ask me that question starting when I was a relatively young dentist. Even more interesting is that the majority of patients who asked me that question when I was younger have long ago FIRED me. As my current patients have watched me get older, they have become realistically concerned that they would need to find a new dentist in the near future and I would like to address that.

I am doing the BEST clinical dentistry of my career at this moment and I want to continue to do this level of dentistry for many years. That said, I am very concerned that my patients continue to receive the level of care that they are receiving now and I will do everything possible to make sure that they will receive great care in the future. I have started to meet with many younger (40+) dentists to determine which dentists might be interested in developing their passion, skill and education so that they will be capable of delivering fine dental care to my current patients. The dentist that assumes my practice will join me In the near future (3-4 years)  to begin  their intense education in the area of fixing teeth and restoring implants at a very high level.

I do not want you to worry about who will care for you when it is time for me to retire. I promise you that I will do everything possible to make sure that you are will have a talented, caring and ethical person to care of you in the future.

You know how much I care for my patients.

Made My Day

I have a patient who travels 3 hours from Potsdam to have me redo some old and unattractive crowns. The case was exceptionally hard and the patient should have had orthodontics (braces) rather than having her previous dentist cut down her beautiful tooth structure for crowns.

Yesterday, I spent 5 hours bonding in her new restorations and I believe that her new smile was pretty spectacular. Last night I received the following text from my patient:

"Home safe-and everyone loves my smile. My kids said it is perfect and my mother said,'now that's a million dollar smile!' I could not be happier or more grateful."

I am honored when a an individual  travels a great distance to become my patient. I am thrilled when I can meet my patient's expectations so that they feel that it is worth making the trip.

My job never becomes boring….I love being a dentist.

Validation

In 1992 I realized that cutting down healthy, beautiful tooth structure (called enamel) made no sense and should be avoided when possible. 1992 was the year that dental researchers discovered bonding agents which allowed dentists to bond porcelain or resin to the inside of a tooth. This  meant that both the enamel and the dentin could be bonded which was a major advancement.  I no longer had to remove ALL of the enamel for a crown and I could simply bond a piece of porcelain or resin in the exact shape of the missing, broken or decayed tooth.

At the same time, I stopped placing mercury fillings and exclusively used resin to repair my patient's cavities. I must admit that neither I nor any of my colleagues had very good resins or protocols for placing bonded resin (white fillings) but we were on our way.

About 10 years ago, a new patient came to my office with root canals having been done in ALL of his upper right teeth and few of them looked very well done. My treatment plan was to place some very large bonded white fillings in all of upper left teeth and place some crowns on the teeth that had recently done root canals. I don't see this patient very often but today I saw him because he was  complaining of pain in his upper right jaw. Sure enough, some of the poorly done root canals were re-infected and I referred the patient to Dr. Banchs, a fabulous root canal expert.

Before the patient left my office I examined the exceptionally large bonded white fillings in his upper left jaw and I was pleased to note that ALL of my restorations were still perfect  and the teeth were strong and healthy.

I strongly believe that dentists should place as few crowns as possible AND learn how to do very well done bonded white (resin) fillings using the proper protocol. When I examined my patient today, I felt that my approach to treating patients which is to keep as much natural tooth structure as possible is absolutely the best way to treat patients. My patients pay me to let them walk out of my office with as much healthy enamel as possible which, by the way, costs 1/4 of the cost of placing a crown.

I feel both validated and vindicated after seeing my bonded white fillings still going strong after 20+ years of service in my patient's mouths.