Wabi-Sabi

 For Richard Powell, "[w]abi-sabi nurtures all that is authentic by acknowledging three simple realities: nothing lasts, nothing is finished, and nothing is perfect."^[4] Buddhist author Taro Gold describes wabi-sabi as "the wisdom and beauty of imperfection."^[5]

Wabi-sabi is a concept in traditional Japanese aesthetics constituting a world view centered on the acceptance of transience and imperfection. The aesthetic is sometimes described as one of beauty that is "imperfect, impermanent, and incomplete." Wikipedia

Why am I bring this up in a blog and how does this relate to my work?

I tell ALL of my patients that EVERYTHING  that I do will FAIL given enough time. I also state that the definition of a good dentist is a dentist that makes things fail at the slowest possible rate.

Yes, ok...again where is this going?

A patient called to say that my filling was 'wearing' and that I told her that my work would not wear..

First of all, I would NEVER make that statement given what I said a few sentences back. Secondly, I know for a fact that a direct resin bonded filling placed under a rubber dam is NOT going to wear in a few short years. Break? Possible because God's teeth break and anything man-made can break because humans can do stupid things with their teeth...Like ummmmm  chewing ice cubes.

Wearing of a new, or relatively new filling of 3-4 years which is how long this patient has been in my practice...is not going to happen. Could it be that one of her fillings that were placed prior to her becoming my patient is failing? Possible.

Nothing  lasts forever...and the ancient Japanese masters recognized this.

"Nothing lasts, nothing is finished and nothing is perfect."

Let's all understand this...because it is a 'perfect' concept.

CEO of Hobby Lobby: Hypocrite

Don't you hate when someone doesn't want to do something because he or she claims that it is against their religion? A few years ago David Green, CEO of Hobby Lobby took the Federal Government to the Supreme Court over a provision of the Affordable Health Care Act. I have no problem with people of faith following their religion. As far as I am concerned, people of faith may have something to teach the rest of us about how to relate to each other.

So what is the problem with David Green and why is he a Hypocrite?

Well he imported stolen property from Iraq...specifically, artifacts that cannot be removed from the country  (Iraq) nor can they be imported into the United States.

Poor David claimed ignorance....Except experts told him that importing stolen artifacts would be illegal. He even lied when he asked that the artifacts be mislabeled to appear legal.

Laws are only for average folks like us and not for billionaires as we have recently come to see.

Now poor ignorant (by his own admission) David has probably never heard of the 10 Commandments and specifically: Thou shall not lie or steal.

Even those laws don't apply to the wealthy.....

And not even his religion could bail him out this time as he was made to return the artifacts and pay a  three million dollar fine.

Poor David...What a hypocrite.

So why am I writing a blog like this? 

Because I don't hurt patients to financially benefit  myself or my office. As you know,  our office motto is: Do The Right Thing. PERIOD.

I won't steal from you or lie to an insurance company. 

If someone does not value quality dentistry, they won't have treatment in our office. And that is ok with us.

No lying, no stealing, no cutting corners.  I will put MY Values against David Green's any day of the week.

Dirty, Lying, Stealing, Crooks

Who could I possibly be describing?

Insurance Companies of course. All they care about is profit and by denying you coverage of your benefits, they earn lots of money at YOUR expense.

Prove it, you say!!!

Remember that I told you that virtually EVERY mercury filling and Every crown that has lasted 25+ years will have leakage, tooth decay or both underneath.

EVERY ONE!!!!

I replaced two 30 year old crowns for a patient in April and we received a note from her insurance company stating that the X-Ray showed no reason to replace the crown.

But

As you all know, I photograph virtually every tooth that I fix for you. See photos below:

Look at the tooth decay on the INSIDE OF THIS CROWN

You do not have to be a dentist to see all the tooth decay on the inside of the old crown or the decay on the supporting teeth.

The Insurance Company will pay for the replacement crowns!

But now even YOU  can see why I call them Dirty, Lying, Stealing Crooks.

Would You Like to See Great Dentistry?

This patient came to my office 3 years ago for veneers. I informed her that she was not a good candidate for veneers because too much tooth structure would have to be removed from her teeth which would weaken them dramatically. BUT, I informed her that Dr. Cooney, my orthodontist, could straighten her teeth with  Invisalign Therapy in a relatively short period of time and that it was important for her to pay him a visit.  Dr. Cooney showed the patient how he would move her teeth and what the final result would be. The patient accepted his recommendations and he successfully moved her teeth. It was then my job to remove her old mercury fillings and all the tooth decay underneath them and rebuild her teeth with very strong bonded resin fillings with no healthy tooth structure being removed. I will tell you with the highest degree of confidence that the vast majority of dentists would have placed crowns on virtually every back tooth in theses photos which, by my count would be 10-11 crowns. In my office, the total cost for crowns, if I did them would have been about $18,000-$20,000. In my office, the bonded resin fillings cost approximately $4,000. Not only did the patient save a considerable amount of money but more importantly she saved her OWN TEETH. (Aside: I thought that Dr. Benjamin is very expensive? Do the math $18,000 minus $4,000 is a saving of $14,000. I am ALWAYS offended when people say that they heard that I am very expensive.)

Sorry for the diversion.

Dr. Cooney calls this one of the most amazing cases that he has ever done and one of his favorite cases. He lectures all over the Northeast lecturing about this case and dentists are amazed by this case. I am honored to have treated this patient and to have contributed to her happiness and joy when she saw the results. And what do dentists from around the world say when I posted this case on DentalXp?  They too are amazed and I hope that you are too.

One of my colleagues wrote the following on a dental forum:
Hi Gerald,

That’s some freakin’ awesome dentistry!  The ortho call was 

obvious, but to restore all those teeth with “just” composite 

is clinically amazing.  

I would’ve likely done crowns on #’s 3, 4, 13, 14, 19, 29, and 30, 

and composites on the others needing restoration.  Frankly you saved 

the patient lots of tooth structure and money.  Congrats!

Here We Go Again

A neighbor stopped me in the hall this evening and told me that the word on the street is that I am retiring:

IT IS NOT TRUE!!!!!!!!!!!!!!

I AM NOT RETIRING ANY TIME SOON!!!!!!

Many of my patients are more concerned about me going away than I am.

I do my very best dentistry today, JUNE, 22 than any day in my career. Why would I retire?

For my entire 40 year career patients have expressed their fears that I would retire and 40 years later, I am still here.

By the way....was anyone else offended when the President said that he had to go all the way to Indiana to find hard working Americans.

Really?

I usually work about 50 hours a week...Is that hard enough, Mr. President?
My last vacation was 1986...Is that hard enough, Mr. President?
I don't care how you feel about the man but he has no right to be disrespectful of those of us who have worked hard our entire careers.

Crowns are Valued by Patients

Dentistry has done a great job with convincing patients that crowns are a very good thing and should be valued. Resin bonded fillings are a mediocre restoration and should take little time and should be cheap.

Unfortunately, the truth is just the opposite.

Crowns are the worst possible restoration for a tooth and should only be placed as a treatment of last resort when no other restoration will save a tooth. The lone exception is back teeth that have had root canals which MUST be protected with crowns.

Patients have been convinced that having a crown is a very positive thing and their insurance company usually even pays for HALF of it which further supports the belief that crowns must be a good thing.

The BEST way to save a tooth is to leave the most amount of natural tooth structure when restoring or fixing a tooth. A crown takes the MOST amount of tooth structure and dramatically weakens the tooth. So why is a crown so valued?????

Placing crowns is a good way to make money.

A good way to save teeth is for the dentist to learn to place well done bonded resin fillings under a rubber dam. Many dentists will tell you that the hole in the tooth is 'too big' for a filling...Sorry that usually means that there is a lack of talent to place a well done bonded filling under a rubber dam.

To sum up this lecture: Well done bonded resins placed with a rubber dam are highly beneficial for a tooth and crowns are highly destructive  to a tooth and should be used sparingly.

(And in my office, you can have 3 1/2 well done resin posterior fillings  for the cost of ONE CROWN.)

OK class dismissed.

(PS: I expect this blog will make many dentists very unhappy.)

No One Gets Bored by Compliments

I received the following card the day after I treated a patient:

I never get tired of receiving thank you cards and notes of appreciation from my patients. I have probably received hundreds of cards like this one over my career and I know that other dentists receive them as well.

What I try to do every day of my professional life is to pursue excellence and try to be one of the best dentists ever. Any dentist that does not try to be the best has become accepting of mediocrity. Most important to me is that many of my patients take notice of our efforts to deliver excellence and be as good as we could possible be.

Why would any patient want to go to a physician or dentist that does not strive to be the best?

Wow!

I just completed 40 full years as a dentist. Exactly 40 years ago today, May 29,1977, I graduated from the School of Dental Medicine, SUNY/Buffalo.

I gave Susan two presents on May 29, a gold snake neckless and a gold bracelet both of which she still has and wears. As I recall, the jewelry cost about $250 which was a fortune back then but I wanted to show Susan my appreciation for supporting me during my dental school career. About 25% of the marriages of dental students did not survive the four years and for good reason...it was a lonely 4 years for spouses.

I am thrilled to have been a dentist for 40 years and my interest has never wavered: Taking care of my patients in the best way possible.  How much longer will I be a dentist? Who knows but I am not ready to leave yet.

May 29, 1977...one of the best days of my life.

A Story That You Have Heard Before

To refresh your memory, I believe that the dental treatment that removes the least amount of natural tooth structure and yet lasts 15 + years is the best treatment for that tooth. That means that a well done direct bonded resin filling placed with a rubber dam is, in my opinion, THE BEST possible treatment especially when compared with a crown which removes ALL of the enamel and weakens the tooth dramatically.

Now remember that I have told you that in my office, a patient can have 3 1/2 resin bonded fillings for the cost of ONE crown. So if I was interested in earning the most amount of money, I would place CROWNS all day long...In reality, there are many days that all I do is well done resin bonded fillings.

Now the story:

We were in Charlotte over the Memorial Day Weekend and went to lunch with one of the other condo  owners. He is in his early 70s and retired so he enjoys spending a few hours with Susan and I. At lunch he related that he and his partner went to the ocean in South Carolina and while having lunch, he was chatting with the young waiter. "Where do you live?" my neighbor asks the young man. "Upstate NY," says the young man."  My neighbor tells the young man that he has a friend who is from  Upstate NY and asks him exactly where he lives. "Saratoga Springs" says the young man. What a coincidence my neighbor says  and asks, "Do you know Dr. Benjamin, a dentist in Saratoga Springs?"

"Oh yes, he is the dentist for wealthy people and I my family is middle class so we don't go to him."

I was shocked by the young man's response. I have probably taken care of more patients for 30+ years than any other dentist in the Capital District and NOT one of those patients could be described as wealthy. The overwhelming majority of my patients  throughout my career have ALWAYS been middle class.  Yes, the last few years I do have some very wealthy patients in my practice but that is the rare exception and not the rule.

Again, a dentist does not become very wealthy conserving natural tooth structure but does so by cutting down as many teeth for crowns as is possible  and ethical.

My goal is help you and  your family keep all of your teeth all of your life. It has never been about maximizing my income.  In fact, I have NEVER had a conversation with my staff about earning more money...It just doesn't interest me.

I feel bad that my reputation is that I only treat wealthy folks.

Dental Inequality

The Washington Post recently ran a story about inequality in America with dental care a strong indication of how separate and unequal our country has become. The full article can be read here:

http://theweek.com/articles/701396/lets-talk-about-dental-inequality-america

I have identified three things that the middle class had in common beginning in the late 1950s and extending to the early 1970s:

1. The middle class ate meat every day...Prior to the late 1950-60s only the wealthy ate meat everyday.
2. The middle class sent their kids to college, also available to only the wealthy.
3. The middle class started going to the dentist on a regular basis in order to maintain their teeth. Prior to this, many folks lost their teeth by their late 20s and early 30s. This was primarily due to the fact that unions had obtained dental insurance for their members. People were tired of seeing their middle age parents take out their teeth and place them in a glass.

There is no doubt that going to the dentist on a regular basis can be a luxury for many that find it hard to pay their bills. My parents sent my sister and I to the dentist every six months and we always had our cavities filled.

So what has happened in the intervening 40-50 years?
1. Dental insurance which used to pay for 8 1/2 crowns every year doesn't even pay for one crown a year...Blame employers who don't care whether their employees have teeth or not.
2. The middle class became less interested in taking care of their teeth and more interested in having larger homes and more than 5 TVs in their homes.
3. Young adults wanted to spend their money on cell phones, cars and vacations.

None of this is a good thing. The middle class must value its health including their teeth. Pulling teeth in children's mouths is a sin.

What is the answer?

A good start is making the very wealthy pay federal taxes. Our President is not the only billionaire who didn't pay federal taxes for 20 years. Every working citizen should pay taxes so that we can help everyone afford a minimum level of dental care.

What do you think?