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My wife is in Hilton Head visiting with her brother and his wife. That means that I have been on my own for dinner this past week and last night was the only time that I actually went out for dinner.
The easiest place to go to and eat by yourself is the Indian Restaurant (Karavalli) in town. I always bring a hard copy of the New York Times when I go out to eat even though I almost always read the paper online.
There was a table of four behind me and I assume that it was a 3 member family with an invited guest. The guest was 22 and a college senior and spoke with exceptional authority on any subject that was discussed. I know, I know...when I was his age, I probably did the same thing. However, I reached a point in my life in my early 40s when I realized how little I really knew about dentistry and went on an education mission which resulted in spending about $4.5 million dollars and getting almost 4500 hours of Continuing Education. ( Aside: in the early 1990s, there were VERY few dentists with a clear understanding of how to diagnose and treat the entire oral system of muscles, teeth, bone, soft tissue, salivary glands and a finicky joint.) Once I started to study I had a better understanding of how much I needed to learn and learn I did.
In the early days, I never tried to impress anyone with how little I knew and never spoke out in a post graduate class. I have been on many international dental websites and it never fails to amaze me how little people know but they say it with such authority.
Today, I know a significant amount of knowledge about restorative dentistry but I don't offer information unless I am asked.
The young man was a great source of entertainment for me. Speaking as an authority without much knowledge may sound great socially but ....
The word 'Wisdom' and youth cannot be used in the same sentence. (Except here, of course. lol)
Sunday, October 19, 2014
Saturday, October 18, 2014
The "Ah Ha" Moment
Life usually goes on in a pretty predictable way. We get up, eat breakfast, go to work etc etc. Sometimes we 'wake up' from the norm and see something that is different from we usually do or think. That moment is the "Ah Ha" moment and it is a game changer for most people.
One of my new patients has been with me for about a year and came to our office as a 'reluctant' patient calling when he was swollen and in pain and forced to ask one of his co-workers who his dentist was. Needless to say we saw him immediately and obtained an appointment for him with Root Canal Experts for an hour later. He had many root canals, had some hopeless teeth removed in preparation for implants and I have been restoring his teeth during this past year.
My patient had a mouthful of old dentistry including root canals, fillings and crowns...all of them relatively poorly done. He was NOT neglectful in taking care of his mouth. This week my patient was in for an appointment, sat down and said to me:
"You know, I was thinking. What is different about your work is that in the past whenever I had dentistry, I always had to go back to the dentist because something broke, something fell out or it did not feel right. Since I have been coming to you, I never have to return for you to 'fix' something that you just fixed."
It occurred to my patient that something was completely different from his previous dental experience and he understood what that was without someone in our office telling him that we try to do excellent work.
The real difference is objective and NOT subjective: More passion, more education, more study and scheduling more time with each patient.
Isn't that different?
One of my new patients has been with me for about a year and came to our office as a 'reluctant' patient calling when he was swollen and in pain and forced to ask one of his co-workers who his dentist was. Needless to say we saw him immediately and obtained an appointment for him with Root Canal Experts for an hour later. He had many root canals, had some hopeless teeth removed in preparation for implants and I have been restoring his teeth during this past year.
My patient had a mouthful of old dentistry including root canals, fillings and crowns...all of them relatively poorly done. He was NOT neglectful in taking care of his mouth. This week my patient was in for an appointment, sat down and said to me:
"You know, I was thinking. What is different about your work is that in the past whenever I had dentistry, I always had to go back to the dentist because something broke, something fell out or it did not feel right. Since I have been coming to you, I never have to return for you to 'fix' something that you just fixed."
It occurred to my patient that something was completely different from his previous dental experience and he understood what that was without someone in our office telling him that we try to do excellent work.
The real difference is objective and NOT subjective: More passion, more education, more study and scheduling more time with each patient.
Isn't that different?
Thursday, October 9, 2014
Technological Misunderstandings
I recently diagnosed a dental abscess for a long time patient and referred her to my favorite endodontic practice, Root Canal Experts. As most of my patients know, I am a general dentist but I limit my practice to fixing teeth and restoring implants, the things that I love to do and what I am good at so I don't perform root canals.
After the initial consultation with Root Canal Experts, the patient sent me an email stating that she wanted a second opinion and she wanted her x-rays sent to another general dentist. My response both in my mind and in my email was, "After 30 years if you don't trust my recommendation (especially where there is literally no money involved on my part), you need to find another general dentist to take care of you." I never mind when a patient has a cosmetic consultation and informs me that they are going for other consultations because that patient will be able to compare my recommendations with other dentists and their work.
I sent my patient a termination letter and the following day, she called in tears stating that she did not mean to offend me or question my recommendations. What she meant to say is that she could not afford to see the best at Root Canal Experts and wanted treatment at a lower cost.
Don't you think that it would have been better if the patient had actually called Donna and explained her situation? Using incorrect words without the opportunity to explain what you really mean is a problem with emails and texts. We THINK we understood what the other person is saying to us without seeing or knowing whether the person is being sarcastic, funny or simply misunderstood what he or she heard.
A 30 year relationship down the tubes and we all lose. SAD
After the initial consultation with Root Canal Experts, the patient sent me an email stating that she wanted a second opinion and she wanted her x-rays sent to another general dentist. My response both in my mind and in my email was, "After 30 years if you don't trust my recommendation (especially where there is literally no money involved on my part), you need to find another general dentist to take care of you." I never mind when a patient has a cosmetic consultation and informs me that they are going for other consultations because that patient will be able to compare my recommendations with other dentists and their work.
I sent my patient a termination letter and the following day, she called in tears stating that she did not mean to offend me or question my recommendations. What she meant to say is that she could not afford to see the best at Root Canal Experts and wanted treatment at a lower cost.
Don't you think that it would have been better if the patient had actually called Donna and explained her situation? Using incorrect words without the opportunity to explain what you really mean is a problem with emails and texts. We THINK we understood what the other person is saying to us without seeing or knowing whether the person is being sarcastic, funny or simply misunderstood what he or she heard.
A 30 year relationship down the tubes and we all lose. SAD
Tuesday, September 30, 2014
What Do Dentists From Around the World Think About My Approach to How I Treat You?
I have been telling you that I post my work on International Dental Sites for the last 15 years or so. I thought that I would show you what one of my posts looks like and what other dentists from the United States and around the world say about my work. My work is currently posted on the Dental XP website and nothing has been edited.
Posted on 09.17.2014 11:12 PM By Gerald Benjamin In Composite Resin
Bread and Butter Dentistry
Posted on 09.17.2014 11:12 PM By Gerald Benjamin In Composite Resin
Everyone likes to see complex cases but it is our everyday work that pays the bills and allows us to attract new day to day patients.
Three simple direct posterior resins that when placed under a rubber dam , placed and carved correctly result in beautiful, undetectable restorations. All cavosurface margins are beveled. The teeth are restored with Filtek Supreme Ultra using bulk fill technique and after carving, the resin is pulled over the bevel with a #2 sable brush. There is no exact margin to stain or leak. The resin is cured using bilateral transenamel illumination using 2 ultra strong Ultradent lights simultaneously.
The technique can be used on any size preparation and any number of missing walls.
Three simple direct posterior resins that when placed under a rubber dam , placed and carved correctly result in beautiful, undetectable restorations. All cavosurface margins are beveled. The teeth are restored with Filtek Supreme Ultra using bulk fill technique and after carving, the resin is pulled over the bevel with a #2 sable brush. There is no exact margin to stain or leak. The resin is cured using bilateral transenamel illumination using 2 ultra strong Ultradent lights simultaneously.
The technique can be used on any size preparation and any number of missing walls.
Occlusal caries maxillary right 2nd molar
LO caries maxillary right 1st molar and occlusal caries 2nd bicuspid
Three teeth ready to be restored
Final restorations mimicking natural tooth structure
Sunday, September 28, 2014
Confirmation
I consulted with a 16 year old young lady and her Mother last week. The mother and father are my patients and they wanted me to treat their daughter rather than the pedodontist (children's dentist.)
I had consulted with this young lady about 2 years ago and I realized that she was not able to breath through her nose. During the last five or so years, dentistry has realized that breathing difficulties have an effect on the size of the mouth and the shape of the face in addition to being a quality of life issue. I don't remember why mom asked me to see her daughter a few years ago but I did strongly recommend that she see a pediatric ear nose and throat specialist to correct her difficulty in breathing threw her nose.
At the consult this week, my patient's mother volunteered that her daughter had her tonsils and adenoids removed as I had recommended and that the ENT specialist said to her, " You must go to a very good dentist because only the best dentists are knowledgeable about the connection between breathing problems and oral complications."
I really try to do the very best that I can to take care of my patients even if it is only a recommendation to see a medical specialist.
Dollars earned: Zero
Reward: Great satisfaction in knowing that I made my patient's life better.
I had consulted with this young lady about 2 years ago and I realized that she was not able to breath through her nose. During the last five or so years, dentistry has realized that breathing difficulties have an effect on the size of the mouth and the shape of the face in addition to being a quality of life issue. I don't remember why mom asked me to see her daughter a few years ago but I did strongly recommend that she see a pediatric ear nose and throat specialist to correct her difficulty in breathing threw her nose.
At the consult this week, my patient's mother volunteered that her daughter had her tonsils and adenoids removed as I had recommended and that the ENT specialist said to her, " You must go to a very good dentist because only the best dentists are knowledgeable about the connection between breathing problems and oral complications."
I really try to do the very best that I can to take care of my patients even if it is only a recommendation to see a medical specialist.
Dollars earned: Zero
Reward: Great satisfaction in knowing that I made my patient's life better.
Sunday, September 14, 2014
If You Don't Know, You Must Learn
This past weekend I attended a course in Charlotte,NC to study a 25 year old technology. Why study something that is a quarter of a century old? Easy! For the first 22 or so years the technology was impressive but mediocre despite the incredible marketing effort by the company.
Another reason I avoided the technology was because I sincerely believe that my job is to save your teeth for your entire life and cutting down teeth is not my idea of saving teeth.
So what is this improved 25 year old technology and why should I learn about it NOW?
The technology allows dentists to restore parts of teeth or the entire tooth without placing all of that gook in your mouth to take an impression. And, it allows the fabrication of parts or all of the tooth in a single visit. I had SIX crowns placed in MY MOUTH this year and I know how unpleasant taking an impression can be for a patient.
It has been my goal for the past almost 40 years to avoid placing crowns in patients under the age of 50 because I strongly believe that crowns in young people probably means that the teeth under the crowns will not survive until old age. Because the majority of my patients have very large direct posterior resins in their teeth, I may have run out of natural tooth structure to place another filling and a crown may be NECESSARY and I am looking down the road a few years to make sure treatment will be as comfortable as possible and functionally excellent.
Am I going to make the move to a technology that is now fabulous? I don't know yet as the cost is significant but it is my job to take care of you in the best way that I know how.
Because of YOU, I never stop learning.
Another reason I avoided the technology was because I sincerely believe that my job is to save your teeth for your entire life and cutting down teeth is not my idea of saving teeth.
So what is this improved 25 year old technology and why should I learn about it NOW?
The technology allows dentists to restore parts of teeth or the entire tooth without placing all of that gook in your mouth to take an impression. And, it allows the fabrication of parts or all of the tooth in a single visit. I had SIX crowns placed in MY MOUTH this year and I know how unpleasant taking an impression can be for a patient.
It has been my goal for the past almost 40 years to avoid placing crowns in patients under the age of 50 because I strongly believe that crowns in young people probably means that the teeth under the crowns will not survive until old age. Because the majority of my patients have very large direct posterior resins in their teeth, I may have run out of natural tooth structure to place another filling and a crown may be NECESSARY and I am looking down the road a few years to make sure treatment will be as comfortable as possible and functionally excellent.
Am I going to make the move to a technology that is now fabulous? I don't know yet as the cost is significant but it is my job to take care of you in the best way that I know how.
Because of YOU, I never stop learning.
Saturday, September 6, 2014
So What Do Two of the Greatest Restorative Dentists Say About My Work?
Hi Benjamin,
This case represents the true meaning of artistic and sound conservative dentistry. Kudos to your perpetual drive for excellence!
Newton (Fahl)
And
And
Good job, Gerald,
I have advocated using composite restorations for over 27 years when I wrote my article on the reasons not to crown endodontic teeth whenever possible and to save the existing enamel. Still too many endodontists routinely recommend full crowns to "protect" the teeth when I feel so many times it weakens the tooth by stripping off all the enamel.
I have advocated using composite restorations for over 27 years when I wrote my article on the reasons not to crown endodontic teeth whenever possible and to save the existing enamel. Still too many endodontists routinely recommend full crowns to "protect" the teeth when I feel so many times it weakens the tooth by stripping off all the enamel.
Newton Fahl and Ronald Goldstein are two of the greatest restorative dentists in the world...bar none. The fact that dentists at that level would even CARE to comment on MY work is, in itself, incredible. And the fact that each saw treatment on only ONE tooth and not a large case that is always impressive and amazing.
Dr. Banchs performed root canal therapy for our patient and she was financially limited at this time in her life but she understood the need to protect her tooth so I placed a direct bonded resin restoration for her rather than placing a crown or an onlay. Limited natural tooth structure was removed and the tooth is strong enough for many years without further treatment. This is the kind of dentistry that I do for YOU every day of the week and what I usually tell you at the end of the appointment is, "Most dentist would tell you that you need a crown on this tooth but I really do not think that it is necessary."
I am honored that two of the best dentists in the world (who are also two of my mentors) would comment so favorably on my work.
I am also honored that you have selected our office for your care. Putting your interests ahead of our (financial) interest is what we have always done.
Thursday, September 4, 2014
It Is Starting Again
For most of my career, long time patients would tell me, "Please don't ever retire." And when you are a dentist in your 40s or 50s, it would sort of make me laugh. My response was usually, "Why would you even worry about that? Don't you have something really important in your life to worry about? Besides who said that I was retiring?"
Now in my final ten years of practice, patients ARE becoming concerned about who will be their dentist a decade from now. Just this week three patients pleaded with me not to retire. My response now is: " I am not retiring so don't worry and in any case, we have been thinking about my successor so that I will be able to work with them for 3-4 years BEFORE they enter our practice and work WITH them for 5-6 years to help them develop into fine restorative dentists.
I then explain that in addition to having fabulous clinical skills, my successor must be highly ethical and devoted to our patients.
This is a very big hurdle for the dentist that will follow me but I am confident that you will be in great hands for the next 10 years and beyond.
Don't you have something REALLY important to worry about?
Now in my final ten years of practice, patients ARE becoming concerned about who will be their dentist a decade from now. Just this week three patients pleaded with me not to retire. My response now is: " I am not retiring so don't worry and in any case, we have been thinking about my successor so that I will be able to work with them for 3-4 years BEFORE they enter our practice and work WITH them for 5-6 years to help them develop into fine restorative dentists.
I then explain that in addition to having fabulous clinical skills, my successor must be highly ethical and devoted to our patients.
This is a very big hurdle for the dentist that will follow me but I am confident that you will be in great hands for the next 10 years and beyond.
Don't you have something REALLY important to worry about?
Thursday, August 28, 2014
Meeting New Young Dentists
When young dentists work with specialists (endodontists, oral surgeons) they sometimes confront dental challenges that they are not comfortable in dealing with. In these situations, the specialists call me and ask if I would mind helping a young colleague with their challenging cases.
What I am learning from working with young dentists is how poorly Dental Schools educate their students. In fact, many of the schools are still teaching the same material that they taught me 40 years ago. Can you imaging MIT or RPI teaching young computer science students the same information that they taught the class of 1971?
Think about this: You are the world's greatest and most knowledgeable expert in carberators, which was the part of the car (up until about 1990) that mixed the gas and air together before it went into the engine. Now I invent fuel injectors which are 10 times more efficient and have none of the issues that prevented your car from starting on a rainy day. How would you feel about my new fabulous fuel injectors?
You would hate them because YOU are not an expert in fuel injectors and you could lose your job. And wouldn't you do everything in your power to make sure that fuel injectors weren't taught to young car mechanics? And wouldn't you tell everyone who would listen how lousy and dangerous fuel injection systems are?
You now have a brief explanation why dental students and my young colleagues are so poorly trained. Dental Schools are experts in teaching 1980s dentistry.
Young dentists have student loans approaching monthly Ferrari car payments ($4,000) at 7% interest and they are not being trained to practice in the modern world.
It is time for a revolutionary change in dental education.
What I am learning from working with young dentists is how poorly Dental Schools educate their students. In fact, many of the schools are still teaching the same material that they taught me 40 years ago. Can you imaging MIT or RPI teaching young computer science students the same information that they taught the class of 1971?
Think about this: You are the world's greatest and most knowledgeable expert in carberators, which was the part of the car (up until about 1990) that mixed the gas and air together before it went into the engine. Now I invent fuel injectors which are 10 times more efficient and have none of the issues that prevented your car from starting on a rainy day. How would you feel about my new fabulous fuel injectors?
You would hate them because YOU are not an expert in fuel injectors and you could lose your job. And wouldn't you do everything in your power to make sure that fuel injectors weren't taught to young car mechanics? And wouldn't you tell everyone who would listen how lousy and dangerous fuel injection systems are?
You now have a brief explanation why dental students and my young colleagues are so poorly trained. Dental Schools are experts in teaching 1980s dentistry.
Young dentists have student loans approaching monthly Ferrari car payments ($4,000) at 7% interest and they are not being trained to practice in the modern world.
It is time for a revolutionary change in dental education.
Monday, August 18, 2014
Lies, Lies and More Lies
I am replacing the 25 year old crowns for one of my long-time patients. No one will tell you but crowns have a life expectancy that is probably in the 20-25 year range. After that, you can be pretty sure that there will be leakage and decay under the crown. I removed two crowns, removed massive tooth decay (see photos), rebuilt the teeth and had my lab fabricate two new crowns. We submitted the fees to our patient's insurance company and they sent the patient a letter stating that I was a lying, stealing, cheating and unethical dentist because they could find nothing wrong with the crowns looking at 150 year old technology called an x-ray.
What they actually said was that they could find no medical necessity to replace the crowns. Did they ask me for supporting evidence such as photographs or a narrative explaining why the crowns needed to be replaced?
NOPE? They would rather tell my patient that I am an unethical dentist. Now if that was actually the case, why didn't the insurance company report me to the police or the FBI as they are required to do because insurance fraud is a felony?
When we received a copy of the same letter that the insurance company sent to my patient we located the photographs that I take of almost every tooth that I treat and sent it to them. You don't have to be a dentist to see the brown mush that was under the two crowns.
Soon after the insurance company received the photographs, they merely said, "NEVERMIND" and agreed to pay for the crown replacements. Did they tell my patient that they had made a mistake and that I am, indeed, honest and ethical? NO!!!!
This is why I don't participate with insurance companies. They lie, they cheat (you) and they steal (from you).
I will always provide you with the best dentistry that I can. I also promise you that I will NEVER perform dental treatment simply to earn money or perform dentistry that does not need to be done.
Now who do you believe?
What they actually said was that they could find no medical necessity to replace the crowns. Did they ask me for supporting evidence such as photographs or a narrative explaining why the crowns needed to be replaced?
NOPE? They would rather tell my patient that I am an unethical dentist. Now if that was actually the case, why didn't the insurance company report me to the police or the FBI as they are required to do because insurance fraud is a felony?
When we received a copy of the same letter that the insurance company sent to my patient we located the photographs that I take of almost every tooth that I treat and sent it to them. You don't have to be a dentist to see the brown mush that was under the two crowns.
Soon after the insurance company received the photographs, they merely said, "NEVERMIND" and agreed to pay for the crown replacements. Did they tell my patient that they had made a mistake and that I am, indeed, honest and ethical? NO!!!!
This is why I don't participate with insurance companies. They lie, they cheat (you) and they steal (from you).
I will always provide you with the best dentistry that I can. I also promise you that I will NEVER perform dental treatment simply to earn money or perform dentistry that does not need to be done.
Now who do you believe?
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12 Comments
"Trust me it's NOT hard " Trust ME it ain't
easy. The way you set up , prep the areas,
especially small ones speaks volumes
I may not be able to do that but I can see
and understand what is exceptional
I'm sure it took few years to master that
How many? 40?
Really Nice
Rocco
Again, dental schools are masters at teaching how to create and fix carburetors in a fuel injection world. Everything is challenging to a dental student and schools believe that placing amalgam is 'hard enough' for students. Nonsense! Teach them and they will learn.
Sadly, resin based dentistry will soon be the way of the past. Few care to learn this fabulous modality of treatment. The destruction of mass amounts of tooth structure for crowns and inlays has become the norm.
I truly believe that what you show should be a goal on daily dentistry and the vision we all have to have for long term teeth survival.
Patient should undergo this type of approach as much as possible.
Thanks for sharing
Armando
I do agree with Armando´s point of view.
Why this images are so unusual?
Thanks for sharing.
Jorge.
Thank you for your comments.
We are losing sight of what our profession is about: allowing patients to keep their own teeth.
Unfortunately, our poor dental school education, our fabulous technology, our talent (or lack thereof) and how we are paid for our work all encourage the mass removal of enamel, the only part of the tooth for long term structural integrity of the tooth. The more tooth structure that we remove, the more we are paid.
In my practice, I tell my patients that what they pay me for is to walk out with every mm of healthy tooth structure...and I charge a significant amount for that.
As I recently told the Dean at the Dental School,
"You need to fire half of your faculty and double the pay." He told me that he could not do that and I told him that if I could, I would fire him. If we do not teach excellence, students will not know excellence.
For the past two decades I have proven that resin is a fabulous material to the scorn and dismay of my colleagues.
It is my belief, which means that there is a small possibility that I am wrong, that dental schools, controlled by the ADA which sets curriculum and requirements, is teaching yesterdays dentistry. This makes it virtually impossible for today's graduates to enter high level practices but also makes them ripe for clinic style (medicaid mills) or corporate style dentistry.
Why even teach mercury based dentistry?
Why don't our young colleagues learn more about occlusion considering all of the information that we have learned over the last two decades?
Why do our young colleagues have such a poor understanding of diagnosis and treatment planning?
Why does the faculty perpetuate the myth that resin, properly placed under a rubber dam to retain the most amount of natural tooth structure is an inferior material to porcelain? Why is the 'standard of excellence' determined by the number of crowns placed?
I make a very good living placing direct resin restorations without destroying tons of enamel.