“I Wish You Bad Luck” Not Political But Enlightening

The Wall Street Journal published an Op-Ed piece in today’s paper in which Chief Justice John Roberts elaborates on this spring’s ninth grade graduation speech.
What Justice Roberts said was:

“From time to time in the years to come, I hope that you will be treated unfairly,so that you will come to know the values of justice. I hope that you will suffer betrayal, because that will teach you the importance of loyalty. Sorry to say, but I hope you will be lonely from time to time so that you don’t take friends for granted. I wish you bad luck, again, from time to time so that you will be conscious of the role of chance in life, and understand that your success is not completely deserved and that the failure of others is not completely deserved either. And when you lose, as you will from time to time,I hope every now and then your opponent will gloat over your failure. It is a way for you to understand the importance of sportsmanship. I hope that you will be ignored so that you know the importance of listening to other, and I hope you will have just enough pains to learn compassion. Whether I wish you these things or not, they’re going to happen. And whether you benefit from them or not will depend upon your ability to see the message in your misfortunes.”

What an incredible message to our children. Forget children...every adult needs to read and understand the Chief Justice’s words.

Truly, this is what WISDOM sounds like. Do we as a nation need more of that as well as kindness, courtesy, compassion and intelligence?

Read and Learn

Have a Happy, Healthy and Prosperous New Year for you, your family and everyone that is meaningful in your life.

We Either Don't Know or We Don't Care (Not Political)

The Congress just passed the 'most sweeping' tax reform in a generation according to the #1 fan of the legislation. The Congress said that the economy would grow because corporation's tax rate would drop from the current 35% to 21%.

Liar Liar pants on fire.

So I Googled "What is the federal tax rate of a big corporation. So what do you think the answer is???

Some corporations pay 21% but a vast majority pay ~12% to 13%.

Don't believe me? Read the report yourself:

https://itep.org/the-35-percent-corporate-tax-myth/

So let me understand this:
1. Corporations already pay less than the "New" tax law.
2. Citizens of NY, NJ, CT, MA and CA are going to pay more tax under the "most sweeping" tax reform in a generation.

The Congress must truly think that the American people, their bosses are fools.

Happy New Year

Every year at this time we need to reflect back upon the year that is about to end and assess what went well , not so well and to appreciate all that we have.

2017 was a tough year for our office.
Donna had breast cancer and her Mother passed away.
This one event meant that we were short handed for almost half a year. Fortunately, Donna has recovered and is healthy.

In early November, I developed significant weakness in my right leg accompanied by intermittent severe pain. Fortunately, after about 6 or 7 weeks, strength in my leg has improved and the pain has disappeared. I visited several physicians and took some tests but my gut feeling was to just wait out the problem and let it resolve.

Did our office have a 'good year?' Acceptable. Average.
(Aside: For all those who think that our office is expensive and make soooo much more than we did in Troy. Think again...I don’t earn any more than I did in Troy because overhead is 4-5 times expensive than the Troy office.)

We would like to continue to grow so that we can take care of all those  'teeth people' who need our help.

Hopefully, 2018 will be a great year for our nation, our families and our office. We wish everyone a Healthy, Happy and Prosperous New Year.

We deserve it.

Fake (Not Political)

98Apparel

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Many of you know that there are some very fine and expensive watches in the world. Patek, Rolex, A. Lange and Sohn are just a few that cost tens of thousands of dollars. To be sure no one needs a fine watch to tell time. However, when an ad on Facebook says,"Our luxury watches are BACK," I immediately went to their website to see more about the watch. So what do we know about the above pictured watch?

It cost $99.00.

Luxury?  $99.00?

The watch LOOKS like it is a nice watch. Why would anyone  say "Our Luxury watches" knowing that this is a throw away watch.

Because is today's world, the news is more likely to be real but the interpretation is not.

A great dentist does not offer free initial exam an x-rays and if you see these ads, think of the luxury watch that cost $99.00

From Project Oriented to Goal Oriented: The Path to Fine Dentistry

My Father was a project oriented type person. What does that mean?  "We have 5 things we have to do today so we have to work fast so that we can get them all done" is what he would say as we would start our tasks on a Saturday. That may seem reasonable to a lot of folks. A GOAL ORIENTED type of person might say, "Listen, we have five things we have to do today but we have to do each of them as well as we can before we move to the next thing on our list."

BIG difference.

So I grew up  a project oriented kid. Let's get it done.

When I purchased my first camera in 1972, I had already met my neighbor Walt who happened to also be interested in photography. He was a goal oriented person. He had no problem telling me that when I printed my photos in our bedroom which doubled as my dark room that I had not focused the lens on the printer so that the  photograph was not as sharp as it should be. Oh and by the way, there are dust particles on the black and white print. Do it AGAIN.

I printed the SAME photograph 8 times until I learned to get it perfect. 8 hours in the dark room and all I had to show was ONE PRINT.

That's how I became a goal oriented person and how I learned that doing things RIGHT is far better than doing things quickly.

I am NOT a fan of either automatic cameras OR PHOTOSHOPPING my photographs....just like the old days..If you couldn't see the the photo in the camera, it was cheating to fix it after the fact. Even though my Mirrorless camera can be fully automatic, I took the above photo in the manual mode with my goal to only have the young girl's dreadlocks in focus. (ISO 200, F2, 1/210 speed pushed one stop.) It was taken on one of our visits to Charlotte while waiting for Susan to get us each a glass of Cabernet.

I had the same level of Passion for photography that I have for dentistry...Aren't you glad that I found photography before I went to dental school? I certainly am.

(You can double click on the photo to see it full screen.)

Politics Aside

If you visit the Upper East Side of Manhattan, you will enter the medical section of the City. Memorial  Sloan Kettering, New York Presbyterian Hospital, Hospital for Special Surgery and Cornell Weill Medical Center all come to mind as being located within blocks of each other. As you walk around the 'Hospital District' you will see many buildings associated with the hospitals have names associated with them. All of the 'named' buildings have been donated by very wealthy individuals  who whether we like them or not, play a very important role in our Society. The Koch Brothers are often criticized for their Conservative leaning views but they have a strong philanthropic side that we all must admire regardless of their or our political views.

Many wealthy individuals and families contribute a great deal to improve all of our lives and we need to put aside OUR political philosophies and say, "Thank you." None of us would refuse treatment at Memorial Sloan Kettering because the building was donated by our political foe. Sometimes we just need to stop and think.

This is THE PROBLEM

"(CNN)A Pennsylvania doctor was indicted Thursday on 19 counts, including charges related to the deaths of five patients to whom he had prescribed opioids, according to the Department of Justice. It alleges that Dr. Raymond Kraynak caused the deaths between 2013 and 2015 by "unlawfully distributing and dispensing controlled substances" to the five.

Prosecutors also say Kraynak prescribed nearly 3 million doses of opioids from January 2016 through July.

Kraynak, 60, of Mount Carmel was arrested Thursday. Prosecutors say he made a first appearance before a federal magistrate Thursday and was scheduled to appear Friday morning for a bail hearing in federal court."

The State of New  York, namely the Governor, has made a big issue of writing for pain medicine. Physicians and dentists have to jump through hoops in order to give a patient 6 tablets of Acetaminophen with codeine which, by the  way is probably what the average dentist prescribes at one time.

What took the pharmacies so long to find Dr. Kraynak? What took the Government so long to indict this drug peddler? He started  writing significant numbers of prescriptions in 2013 and next week it is 2018.

The Government has to stop harassing caring physicians and dentists and shut down the pill pushers.

An Interesting Article inToday's New York Times

Every day patients ask me how much longer I will be working and everyday I tell my patients that I have no interest in retirement.

Well I am not alone among professionals. On pg. 5 of the Business Section of Times there is a story about professionals like me who have no interest in retiring.

"Dr. Laura Popper, 71, a Manhattan pediatrician works because her professions central to her identity.  'I wanted to be  a doctor since I was 4---why would I give that up?"

There was also mention of a Federal District Court Judge, Jack B. Weinstein who is 96 and says that he has no intention of retiring.

Like Dr. Popper and Judge Weinstein, I have no intention of retiring any time soon. Let me assure you that I am doing the best work of my career at this time in my life. And just so that you know: I wanted to be a dentist since age 9 and I have the distinction of being rejected from almost all the American dental schools at least once 3 years in a row. Do you think that I was determined to become a dentist and driven to try to be among the best of my profession?

One of the most disheartening things that I heard yesterday was from a Canadian dentist practicing for only 18 years. He told me that he cannot wait to retire because he found running a practice and doing dentistry very hard and very stressful.  He was jealous when I told him that I LOVE being a dentist when we were chatting on Facebook Messenger. How sad it that?

If you would like to read the article yourself:

https://www.nytimes.com/2017/12/16/business/asked-about-retiring-they-have-a-simple-answer-why.html?ref=todayspaper

A New Marketing Campaign

I have read that some company is placing billboards and taking out ads that read:

"It is Easier to Find a Good Dentist Than You Think" or something to that effect.

The reality is that it is damn hard to find a top notch dentist or physician/surgeon than you think.

I have told my blog readers before the criteria that they should use to find a great dentist but I will provide that list again. This is MY OPINION and while there may be one or two additional criteria, this list is pretty complete.

1. The dentist should have 3,000+plus hours of continuing education and none of those courses should be vacation/courses.
2. The dentist should routinely use a rubber dam to restore posterior teeth.
3. The dentist should not participate with many insurance companies because fees are set low by the insurance company and the dentist cannot spend an appropriate amount of time per patient.
4. The dentist should photograph virtually every tooth that they restore for both educational and legal reasons.
5. Quality dentists usually see one patient at a time rather than 2-4 patients at the same time.
6. Quality dentists usually schedule ONE patient for 4-7 hours when treating large cases.
7. The dentist should have a fabulous website with many of their OWN cases on the website.
8. The dentist should not try to do all of the specialties of dentistry in their office and should refer to dental specialists. One dentist cannot be a master of all of the specialties  in dentistry.
9. The dentist should be on the faculty of a dental school

So how do I stack up against these criteria?

1. I have 7,000 quality hours of Continuing Education with much of it with the best dentists in the world.
2. I always use a rubber dam in the posterior region of the mouth when restoring teeth.
3. I participate with NO insurance companies because it is my job to be the best possible dentist that I am capable of being. I can only serve one master: my patient.
4. I do photograph virtually every tooth that I restore and show every patient the leakage and/or tooth decay that was under their old fillings.
5. My shortest appointment is ONE HOUR. My longest appointment this year was 9 hours 45 minutes to treat ONE PATIENT.
6. My large cases are almost always allotted one full day of my time.
7. My website is professionally done and only MY ACTUAL PATIENTS are shown on the website.
8. I am a general dentist that limits my practice to fixing teeth and restoring implants from very simple cases to cosmetic and full mouth rehabilitation. All other treatment is referred out to quality dental specialists so that you are always treated by fabulous specialists. I am not a jack of all trades and a master of none.
9. I am and have been an Clinical Associate Professor at SUNY/BUFFALO School of Dental Medicine with a  visiting status.

Finding a quality dentist is NOT as subjective as you would think. There are STANDARDS by which every dentist can and should be measured.

Some People ARE Getting It

Last week a successful person in Chicago sent me an email requesting a consult because she no longer will accept having her teeth cut down and (ultimately) destroyed by crowns.

Wait a second...How did a person in Chicago know 'enough to say enough is enough?'

She reads my blogs and she now KNOWS that crowns are used much too often especially when there are alternative materials and techniques that can DELAY and perhaps prevent the need for a crown.

It is my belief backed up by 25 YEARS of clinical experience with placing direct posterior resins using a rubber dam and strict attention to adhesive protocols, that the majority of crowns placed in patients mouths (NOT MY PATIENTS) can and should be avoided until the patient reaches middle age (50+ years old).

My inquiring email prospective patient asked me BLUNTLY, "Why do dentists want to do so many crowns?"

To digress a moment. Dr. James Andrews is the foremost sports medicine surgeon in the country. Six or so years ago he was interviewed by the New York Times and was asked why so many MRIs are done. His response to the reporter was, "There is nothing that I can learn from an MRI that I couldn't learn by talking to a patient, touching a patient or asking them to perform a task." The TIMES reporter probed further and asked again, 'Then why are so many MRIs done?" To his credit Dr. Andrews told the truth when he said, "It is the money."

Why are so many crowns done instead of direct posterior resins, (my restoration of choice)?
There are several reasons besides the money.

1. Dentists have been told over and over that resins aren't good materials for large posterior resins.
2. The literature shows that the average (and in my opinion, poorly done) resin filling lasts only 7 years. ) My resins are lasting 20+ years)
3. Many dentists have never been taught how to properly place a posterior direct resin and therefore the resins are not done correctly for long term service.
4. 95% of dentists do not use a RUBBER DAM for placing posterior resins despite all manufacturers demands that a DAM be used for complete isolation.
5. Insurance companies know how poorly done posterior resins are done and refuse to pay for them beyond what a mercury filling cost.

So why so many crowns: It IS the money.

Again in my practice a crown fee is $1750. Most of the time my patients are having posterior resins instead of crowns at a fee of $345-$400..

So you see. It is NOT ABOUT THE MONEY.

Hey it is YOUR tooth structure that is being ground down...Not in MY mouth, My staff's mouth, my friend's mouth or my patient's mouth.

Why are millions of implants done? Because, in my opinion and from my vast clinical experience, so many teeth are cut down for crowns and when the crowns fail, they take the tooth with it.

So the lady in Chicago got wind of a what an old dentist is doing in Saratoga Springs and is ready to make the trip.

It IS Official: Our Government Is Run By Idiots...DEFINITELY NOT POLITICAL

I really don't care whether you like our current government or whether you voted for or against our government.

The government is officially run by idiots. How and why do I say this? Read on:

(CNN)Officials at the Centers for Disease Control and Prevention, the very agency tasked with saving and protecting the lives of the most vulnerable, are now under order by the Trump administration to stop using words including "vulnerable" in 2018 budget documents, according to The Washington Post. For the full story read it here: http://www.cnn.com/2017/12/16/health/cdc-banned-words/index.html

So what are these dangerous and forbidden words. Are they the 7 words banned by the FCC and made famous by the comedian George Carlin? You KNOW what they are and if you don't remember you can go to YOUTUBE.COM and search for the 7 Deadly Words.

So again WHAT ARE THE CENSORED WORDS that are not curse words?

"diversity," "fetus," "transgender," "vulnerable," "entitlement," "science-based" and "evidence-based."

Where will this end? What else will we not be able to say or read? In his classic novel, It Can't Happen Here , Sinclair Lewis wrote about the possibilities of a dictatorship in the United States.

How do you think dictatorships start?

Fake News
Banned words
The New York Times is a failed newspaper
We had bigger crowds than at any previous Inauguration
The CIA are Nazis
The FBI's behavior is disgraceful

Again, please do not think that this is a political post. When a government agency, the science driven CDC, is forbidden to use 7 words we all better sit up and take notice.

Physicians and insurance

If  you haven't been in our office during the last month, you won't know that  I am currently using a walker because my decrepit old right leg, injured 40 years ago is getting weaker. I have been taking tests and  x-rays to help determine the  problem.

How a patient is treated often is determined the type of insurance that they have. For instance, I called a doctor's office today and asked about having an MRI. The office person told me that because I have Medicare  (as well as a full private insurance policy just like the majority of people reading this blog) I do not need a prior approval to have an MRI if my physician believes that I need one.

There are Physiatrists in NYC that will offer better options than Physiatrists in the Capital District because their patient WANT treatment that is NOT covered by insurance.

Is that how we should be treated. Is THAT a standard of excellence?

In my office, our patients are provided with the best option to fix a tooth that preserves the most amount of natural tooth structure without regard to how much money that I earn from it. The vast majority of my patients do NOT receive the most expensive option of a crown because it the most DESTRUCTIVE way to fix a tooth. YES, I would earn the most money to place a crown on your tooth but YOU would pay a heavy price for that crown 25  years down the road.

We should treat our patients as if they are our family...Not by what an insurance company pays or how much money the doctor can earn.

But by doing what is best and right for the patient.

"The Old Guy Look"

I can look at a 60 year old person and immediately tell  that their teeth are all worn  down or that their denture is very old.

Why is that?

The movies portray a witch as a person with no teeth and the nose and the chin almost touch. What stops the nose and chin from getting close to each other are the teeth.When an older person's teeth are all worn down,  they develop an 'old guys look' with the corners of the mouth curved down, the lip is all caved in and the chin and nose are closer than they should be.

I just don't get it. One does not need to be a dentist to be able to see the old person's face is collapsing. Look at your family photos and you will see what I am talking about.

Yes, it is often about the finances of the person...but just as often, it has nothing to do with the wealth of the person. They don't care how they look and unfortunately the vast majority of dentists are not willing to discuss the visual appearance of their patient because they don't have an understanding about how to successfully fix the problem.

Look at your parents, grandparents and older friends and see if you see the 'old person's look.' Or just look in the mirror if you are older.

Fix the problem if you can so that you will no longer look grumpy all the time because  of your mouth being curved down.

Irresponsible (Not political)

It has been over 50 years since the Congress enacted major tax changes. I am not necessarily for or against the specific changes in the law. Do I think that the tax laws need to be changed? Absolutely!!!

 It is December 1, 2017 at 5:32 in the evening and supposedly the Senate is going to vote on the tax law.

There is only one problem.

No one in the Senate has read the law....NO ONE.

Not a single Senator has read the bill that they will vote on this evening and they have no clue what is in the proposed new law.

This is no way to run any government or any company no less the greatest, most powerful country in the world.

Maybe it is time to pass a law the dictates that  a Congressperson READ a bill before they vote.

If it was up to me....I would fire them regardless of which party was in control.