Sunday, I went to the "Man up" event hosted by the Durable Goods movement.
It got me thinking about the state of dentistry, and about value to the consumer.
In particular, I thought about the value of my service.
Many dentists follow established guidelines by insurance companies regarding how often they need to replace restorations or crowns. For instance, a crown can be replaced as often as every 5 years, and a filling every couple of years .
However, these insurance companies aren't dentists, and these standards are the minimum accepted. Additionally, one should look into the modes of failure:
1. Recurrent decay (most common):
If you don't brush and floss, all bets are off. Recurrent decay will set in, and undermine the area holding your restoration in place. Most failure is due to recurrent decay from bacteria that feed from stuff between your teeth. If you keep it clean, you should be good.
2. Crown Fracture (common for porcelain, amalgams)
If there was not enough material, or too much stress, or some sudden trauma, porcelain will fracture. Porcelain crowns look nice, and have a higher hardness than enamel or gold. However, porcelain fails by fracturing. Gold will deform into place.
3. Tooth Fracture ( Amalgams)
Amalgams are retained by mechanical retention. This means that they wedge against the teeth to stay in place. Amalgams tend to have a different thermal expansion than enamel, so will constantly wedge against the sides of teeth. That being said, they have self-sealing margins and can 10+ years if taken care of.
4. Shoddy work
I hate to admit this, but I've seen shoddy work. These include crowns with open margins, bad contours, and grossly plus or sub margins. Largely, this is from some non-American accredited provider. Often these are from patients that ask for a workup, go to China, Mexico or XYZ, and get cheap dentistry.
Frankly, I don't touch these unless a.) it's fixable and b.) my patient allows me to redo them.
I believe that you get what you pay for. Although, in my case you probably get more than you paid for. If I believe my work is sub-par...I'll make it right. Period.
That's my policy, and I'm sticking to it.
-Dr. Goodtooth
Tuesday, February 2, 2010
Wednesday, January 27, 2010
Something came up
I won't be posting too much because I'll be heading out to rural Cambodia.
It's not a vacation in the usual sense, but it is an amazing opportunity for me to get in touch with a corner of the world where the dental needs are very real.
On 2/17, I'll be flying extra budget class to Phnom Penh via EVA air.
After a day of acclimating, out team will be going into the countryside to the villages to do missionary dentistry using portable operatories, headlamps, and a kerosene generator.
We'll be done on 2/28, but I'll probably have to wait around Pnom Penh until 3/4 due to the Chinese New Year rush of flights.
I'll keep you updated sporadically.
-Matt aka Dr. Goodtooth
It's not a vacation in the usual sense, but it is an amazing opportunity for me to get in touch with a corner of the world where the dental needs are very real.
On 2/17, I'll be flying extra budget class to Phnom Penh via EVA air.
After a day of acclimating, out team will be going into the countryside to the villages to do missionary dentistry using portable operatories, headlamps, and a kerosene generator.
We'll be done on 2/28, but I'll probably have to wait around Pnom Penh until 3/4 due to the Chinese New Year rush of flights.
I'll keep you updated sporadically.
-Matt aka Dr. Goodtooth
Tuesday, January 12, 2010
A touch of lube
A touch of lube.
It sound somewhat wrong...
but there's something nice about a dab of Petrol Jelly on the lips.
When I'm in the dental chair, my lips get dry.
I feel each tug on the lips more acutely.
And it gets more annoying with each minute.
A touch of lube says I love you in a nonsexual, nonthreatening way.
If you're ever in my chair and I forget the lube,
please let me know.
-Sincerely, Dr. Goodtooth
ps. Dr. Goodtooth receives no endorsement or support from different lube companies. Dr. Goodtooth also does not express any opinion regarding the use of lube, KY jelly, or Vasalene for any other purpose than moisturizing a patient's oral mucosa in the dental chair. Dr. Goodtooth does not endorse misuse or deviant abuse of lube (as it may result in bodily injury and/or discomfort). Please use lube in a responsible manner.
It sound somewhat wrong...
but there's something nice about a dab of Petrol Jelly on the lips.
When I'm in the dental chair, my lips get dry.
I feel each tug on the lips more acutely.
And it gets more annoying with each minute.
A touch of lube says I love you in a nonsexual, nonthreatening way.
If you're ever in my chair and I forget the lube,
please let me know.
-Sincerely, Dr. Goodtooth
ps. Dr. Goodtooth receives no endorsement or support from different lube companies. Dr. Goodtooth also does not express any opinion regarding the use of lube, KY jelly, or Vasalene for any other purpose than moisturizing a patient's oral mucosa in the dental chair. Dr. Goodtooth does not endorse misuse or deviant abuse of lube (as it may result in bodily injury and/or discomfort). Please use lube in a responsible manner.
Tuesday, January 5, 2010
Christmas, and a note about Emergencies
The good thing about having a close relationship with your dentist, is that extraordinary services are sometimes received.
The bad thing, as a dentist, is rendering extraordinary services at inopportune times:
This past Christmas, I received a knock on my door at half past midnight.
It wasn't Santa Claus. It was mom.
She had lost her temporary crown, and was rather agitated. Nevermind that I'd warned her about it for the past three weeks straight. Nevermind that she'd held off making an appointment for six months.
It was mom, and she was in my room.
Later on in the morning, I stumbled into the office under the heavy influence of caffeine. I setup my operatory. I brought my special toys: suction mirrors, surgical light, and a plan B, plan C and plan D. For good measure, I had an E in my little bag of tricks.
The permanent crown went in with no problem, save for mom's tendency to do sit ups at inopportune moments. She'd also lecture me about patient comfort during crown delivery, when I was placing the throat pack.
It wasn't too much of a problem, just a bit annoying. It's mom.
I'd do it for any one of my patients.
Unfortunately, she spent the rest of Christmas bragging about it to relatives.
Note to self: don't take any more relatives as patients.
-Dr. Goodtooth
Note: While mom has occasional bouts of craziness (not limited to chopping down a tree, writing a book, killing crabs, and starting various one-woman crusade for various causes), Dr. Goodtooth and Mom maintain friendly relations and a fair trade collaboration agreement.
The bad thing, as a dentist, is rendering extraordinary services at inopportune times:
This past Christmas, I received a knock on my door at half past midnight.
It wasn't Santa Claus. It was mom.
She had lost her temporary crown, and was rather agitated. Nevermind that I'd warned her about it for the past three weeks straight. Nevermind that she'd held off making an appointment for six months.
It was mom, and she was in my room.
Later on in the morning, I stumbled into the office under the heavy influence of caffeine. I setup my operatory. I brought my special toys: suction mirrors, surgical light, and a plan B, plan C and plan D. For good measure, I had an E in my little bag of tricks.
The permanent crown went in with no problem, save for mom's tendency to do sit ups at inopportune moments. She'd also lecture me about patient comfort during crown delivery, when I was placing the throat pack.
It wasn't too much of a problem, just a bit annoying. It's mom.
I'd do it for any one of my patients.
Unfortunately, she spent the rest of Christmas bragging about it to relatives.
Note to self: don't take any more relatives as patients.
-Dr. Goodtooth
Note: While mom has occasional bouts of craziness (not limited to chopping down a tree, writing a book, killing crabs, and starting various one-woman crusade for various causes), Dr. Goodtooth and Mom maintain friendly relations and a fair trade collaboration agreement.
New Years at the Race tracks
New Years night was a blast: watching fireworks on the Embarcadero with friends and a hidden beer, weaving through cars and inebriated pedestrians by bike, and finishing the night with champagne and whipped cream.
However New Years day was more special, since I got a chance to meet up with Dr. Alton Lacy.
Dr. Lacy is a friend, horse racing aficionado, and possibly one of the world's best restorative dentist. It was $1 day at Golden Gate Fields, and a chance to see something that he loves. Amidst the cheap beer, cheaper hotdogs, occasional bouts of frenzied screaming in Cantonese, Vietnamese, Spanish and occasionally English, I learned something profound.
I learned that a dentist has a very definite shelf-life.
Towards the end, a dentist loses the facility to do dentistry. They lose the passion to perform, the physical ability, or both.
Often, a dentist will have a period where they enthusiastically throw themselves at work. Life is exciting, despite teh best attempts of Insurance companies to otherwise. Journals and study clubs are consumed with delight. Patients and staff are treated well, business picks up.
However, there's a point that ends it.
The trigger may be the wife, the kids, or simply the feeling of ennui. It may be that the dentist feels like they've mastered everything regarding dentistry. It may be that the dentist is saddled with an overabundance of loans and a paucity of sound investments. Or it may be that the dentist doesn't care.
Dr. Lacy isn't there yet, despite being well past retirement.
While we were eating, his tooth fell out.
He wiped it off, dunked in beer, and stuck it back it place.
Later in the night, he will make a custom composite post for himself.
Later still, he'll cast a custom buildup in gold, and cement it.
Dr. Lacy doesn't really accept new patients anymore.
He's too busy taking care of the ones he has.
However if you're ever interested in contacting him, give a call to Dr. Don Curtis in Berkeley, where he moonlights on some Tuesdays.
-Dr. Goodtooth
However New Years day was more special, since I got a chance to meet up with Dr. Alton Lacy.
Dr. Lacy is a friend, horse racing aficionado, and possibly one of the world's best restorative dentist. It was $1 day at Golden Gate Fields, and a chance to see something that he loves. Amidst the cheap beer, cheaper hotdogs, occasional bouts of frenzied screaming in Cantonese, Vietnamese, Spanish and occasionally English, I learned something profound.
I learned that a dentist has a very definite shelf-life.
Towards the end, a dentist loses the facility to do dentistry. They lose the passion to perform, the physical ability, or both.
Often, a dentist will have a period where they enthusiastically throw themselves at work. Life is exciting, despite teh best attempts of Insurance companies to otherwise. Journals and study clubs are consumed with delight. Patients and staff are treated well, business picks up.
However, there's a point that ends it.
The trigger may be the wife, the kids, or simply the feeling of ennui. It may be that the dentist feels like they've mastered everything regarding dentistry. It may be that the dentist is saddled with an overabundance of loans and a paucity of sound investments. Or it may be that the dentist doesn't care.
Dr. Lacy isn't there yet, despite being well past retirement.
While we were eating, his tooth fell out.
He wiped it off, dunked in beer, and stuck it back it place.
Later in the night, he will make a custom composite post for himself.
Later still, he'll cast a custom buildup in gold, and cement it.
Dr. Lacy doesn't really accept new patients anymore.
He's too busy taking care of the ones he has.
However if you're ever interested in contacting him, give a call to Dr. Don Curtis in Berkeley, where he moonlights on some Tuesdays.
-Dr. Goodtooth
Resolutions for the 2010
2010 is here, and still fresh smelling.
This year, I've decided to make some fairly easy to keep resolutions:
-Dr. Goodtooth
This year, I've decided to make some fairly easy to keep resolutions:
- Sleep more
- Get off my butt and make something
- Have fun with friends
-Dr. Goodtooth
Tuesday, December 15, 2009
A visit with Dr. Curtis
Last Wednesday night, I had the fortune of visiting Dr. Don Curtis in Berkeley.
He's a respected professor at UCSF, and someone that I admire.
Along with an elite crew of instructors, he instilled in me the importance of rigorous instruction.
He's also a third generation prosthedontist.
When we were chatting, we didn't talk too much dentistry.
There were a couple of casts and some impressions that he wanted to show me.
However, I wasn't too impressed that he's an expert in his field.
I was impressed by how he cares for his patients and for future generations.
When I was waiting for him, a rather distraught lady came in.
She had been terminated from her position in a rather harsh way.
He gave her a sympathetic ear and his undivided time an hour after closing...and he'd do that for any of his patients in a heartbeat.
He's also a true treehugger.
He takes an hour to get to work by bike, BART, and bus although it's 20 minutes by car.
He lives out his convictions in each case that he restores.
Each case is meticulously recorded and built up to spec before it touches a patient.
We believe that it's not right figure out mistakes on the patient.
Dr. Curtis, I salute you!
-Dr. Goodtooth
ps. Opinions voiced are solely that of Mr. Goodtooth of California. These opinions do not represent the opinions of Dr. Goodtooth of Canada or other places. Dr. Goodtooth receives no financial or other benefits from Dr. Curtis. There is also no affiliation with Dr. Curtis aside from being a former student and a friend.
He's a respected professor at UCSF, and someone that I admire.
Along with an elite crew of instructors, he instilled in me the importance of rigorous instruction.
He's also a third generation prosthedontist.
When we were chatting, we didn't talk too much dentistry.
There were a couple of casts and some impressions that he wanted to show me.
However, I wasn't too impressed that he's an expert in his field.
I was impressed by how he cares for his patients and for future generations.
When I was waiting for him, a rather distraught lady came in.
She had been terminated from her position in a rather harsh way.
He gave her a sympathetic ear and his undivided time an hour after closing...and he'd do that for any of his patients in a heartbeat.
He's also a true treehugger.
He takes an hour to get to work by bike, BART, and bus although it's 20 minutes by car.
He lives out his convictions in each case that he restores.
Each case is meticulously recorded and built up to spec before it touches a patient.
We believe that it's not right figure out mistakes on the patient.
Dr. Curtis, I salute you!
-Dr. Goodtooth
ps. Opinions voiced are solely that of Mr. Goodtooth of California. These opinions do not represent the opinions of Dr. Goodtooth of Canada or other places. Dr. Goodtooth receives no financial or other benefits from Dr. Curtis. There is also no affiliation with Dr. Curtis aside from being a former student and a friend.
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