Thursday, June 25, 2015

Website up

We've been working on this the last 2 months or so, but Monday we launched our website.

It's been 6 months.  There have been substantial improvements: new chairs, new team mates, digital imaging and X-rays, and better tools.

It's been grueling and mentally draining.

The first two months was survival.  I'd found problems in the practice that jeopardized patient safety and privacy.  Billing was wrong.  Accountability was missing.  Core equipment was missing or broken.

Through all this, God provided just barely enough to pay the bills.  No surplus.  No deficit. 

As mom says, like mana from heaven.

Wednesday, June 10, 2015

A very patient patient--going to the extreme to deliver my very best dentistry--ie: the crown seat from hell.

I have to thank my patient Larry for allowing me to indulge in my vanity.

Some time ago, there was a problem with his previous crown.  It was leaking.
He told me, "just do what you think is right, doc."

I told him gold was king.  He let me do it.  We took the impression with hydrocolloid...twice.
Retention slots were drilled in the second time to improve longevity on a very short, worn out tooth.

Then, I spent 8 hours waxing his crown...attempt 1 was useless since we needed a new impression and retention slots.  After another 8 hours, the second attempt at waxing his crown was a fail (wax cracked during storage).  After yet another 4 hours, the margin broke off...my mentor told me to use a different wax.  And after another 2 hours, we had a wax pattern...we casted the crown in JCB gold from Jenson industries--about $700 worth of gold (including the button).

It was a fail.  The sprue was too short.  There was a bubble right in the middle of the crown.

After another 4 hours of waxing, I presented another wax pattern to my mentor...which was deemed "not tooth shaped."  He rewaxed my crown in under 20 minutes.  We resprued, and recasted the crown.

Today, I spent 2 and a half hours to cement a crown.
I'd repolished the mesial contact to a perfect, wide contact.
The crown would only seat in one direction, with a 2-5 degree tolerance of seating.
Also, this is tooth 15...the last tooth in the mouth.
Lastly, the crown would be almost impossible to remove once seated...even without cement.

Translation....good God this is hard!

5 attempts later, we finally have the thing perfectly seated.
The calibrated, single dose glass ionomer cement would set before I could fully seat this thing.
The margins were burnished and polished flush to the tooth.
The occlusion was adjusted to have 3 point contacts on each teeth.

This is the very best dentistry that I can humanly do...but I wonder at the cost (to me).

Anyways, I owe Larry a debt of gratitude for his patience and understanding.


Thursday, August 21, 2014

I'm getting FICOI. Layaway at Detroit


This is I'm not sure what to make of Detroit.

It's 3:25 am California time.  There's a godawful eyesore from concourse A to concourse B:
This is the self styled "Vegas Light show."  Aargh!!!! 

On the plus side, the sunrise is beautiful.
It beats the crap out of San Francisco fog.


However, I think SF beats Detroit in many other ways...

Thursday, July 24, 2014

I have TMD

As of yesterday, I have a temporal mandibular disorder (TMD).  I've included a work up because it may be helpful for others to see how I work up a case.

"I've been working 6 days a week, 10+ hour days, and my responsibilities have increased (with no increase in pay, and more bills to pay).  I'm having a dull ache on opening on the right side, but is fine at rest.  There are no joint noises noted.  My right jaw muscle is sore to touch.  I can open, but it hurts to open all the way,  Chewing makes it worse."

My thinking sequence:

1. What is affected?
         The Temporal Mandibular joint is comprised of nerve, muscles, and a joint.  Each type of injury will manifest differently.

2. What caused it?
          Masking pain is bad.
Removing the cause of pain is ideal.
Diagnosis is key.

3. What do we do about it?
          The best situation is to create conditions for optimal healing.  Often times, the best treatment is nothing. 
         Merely managing pain is a second resort, and only for various severe circumstances.  Pain pills, muscle relaxants, and surgery all have side effects.


Okay.  Hete's my work up:
1. What is affected?   
+Muscle, specifically right masseter.   
     The area is tender to the touch.
     There is a soft end feel---max opening is possible, but with effort.  Think of forceful over stretching a cramped muscle.
+There are no joint noises, possible indications of osteoarthritis. 
+The pain is only during function, ruling out nerve damage (constant pain, no pain)

What caused it?
-no trauma noted.
-no fever noted, ruling out infection/inflammation
-no medications were noted, thus ruling out inflammation 
+ elevated stress was indicated.  
        Because of the muscle pain was likely from elevated stress, the cause of pain is likely psychosomatic.  This is fairly common in today's society with more stress.

What do I do about it?
+ The cause is psychosomatic.
+ In my case, I need to reduce my stress, exercise, and relax more. 

I hope that this is been helpful for you. Thank you for checking out my blog.

Saturday, June 14, 2014

Traveling tips

I'm on my way to a wedding--red eye flight.  This is my first non business related trip in a long time.

Here are tips that keep me from going crazy:

1. Good Luggage--
+mine is slightly smaller than standard, so it won't get rejected.
+great spinners--less strain
+expandable.
+lifetime warrantee
+my policy is one carry on bag, no problem
+packing cubes and folders make for fast TSA approval--no wrinkles, on the clothes at least.

2. Smartphone
+eboarding pass
+econfirmations
+infinite maps regardless of terrain
+in a pinch, it accesses currency via PayPal and bank sites
+with the Sleep Cycle App, it acts as a very effective way to combat jet lag.

3. Flashlight
+Mine is the 4sevens quark miniAA.
+you never know when you'll need it, my best use of a flashlight was to explore the ruins of Siam Reap at 3 am.  I believe it was the royal library.

4. GPS
+for any business trip where you need to rent a car, a reliable gps is very useful.
+at 1 am, do you really want to fumble for a map?

5. Portable office
+Mine is a refurbished MacBook Air and a used Fujitsu S1100.
+This combo has been immensely useful for taxes and tracking deductions.

6. A great pen
+In Japan, many are too bashful to speak English.  Signs, pictures and maps are universal.
+Keeping a Journal is a great way to be sane.
+in a pinch, they can be used for personal defense.  

7. Sense of Humor
+this is probably the most important thing for a traveler.
+Delays?  Layovers?  Fodder for jokes or bonding
Ps. If I were the model's dentist, I'd be ashamed.  Look at those hyperextended incisors!  And the embrasures are excessive!  (Yes, I'm a dental nerd).

Thursday, March 13, 2014

The kindness of strangers--SFO

I'm at SFO waiting for flight UA-1536 to Vegas.  

At first it's smooth sailings.

At 5:59 PM, I got a call from United airlines warning off possible delays.
I leave for SFO at 7:49 PM (late, I know).
The promised Bart is missing--arrival at 9:00 PM.  No worries...flight at 10 PM.

Then stuff gets messy.  

I get on blue line--wrong way!  At Westfeild, I and a fellow straggler hustle to reverse course: 9:03 PM.  Gate 3 at 9:10.

Meanwhile, UA1536 is noted as on schedule to *leave* at 9:18 PM.

Security check.  Crap!  Nice airplane lady waves me to front--still another row!  9:12 PM.  The couple in front of me graciously lets me pass.  9:14 PM.  Security doesn't body search me (unusual).  9:16 PM.  I barrel to gate 73 and almost knock over a dainty brown haired dude in front of his son.

And the flight is delayed to 10 PM.

Thanks to all the gracious strangers.
I really appreciate your consideration.

I love my job

Some days are awesome--like today.

There's a young lady from LA.  She's a new patient.  It's first time to the dentist by herself.  She says she needs a root canal, and shows me this: 
The dentist in LA lopped off half her tooth.  To their credit, all decay was removed.  Sadly, there was no attempt to temporize things--just a grungy cotton pellet with a spot of dried blood.

So I pray.

The tooth is infected, but the nerve is dead.
The tooth is open.  I file the canal.  The apex locator isn't working, so I pray and feel for the apex.

And God answers.
This is *exactly* what I want.  I finish cleaning and shaping.   Irrigate with my special mix, and fill the canal:
Gracias a Deus!

The rest was fun: build up core with Fuji iiLC.  Reinforce with A2 composite.  Create a layered buildup that looks like God intended:

The tongue side is uglier.  I wanted to make sure that this tooth doesn't get fractured.  (The stain is blood under the composite overlayer--no worries.  It didn't interfere with the core Fuji buildup.

Uurgh.  Ugly.

Anyways, I have to thank God that my patient is out of pain and can smile.