They say that the title of any article or blog post should grab your attention so hopefully that’s why you are reading this. Did you know that April is oral cancer awareness month? No, well that’s not a surprise because we don’t really hear about it in the media. We seem to hear about cancers such as lymphoma, cervical, thyroid, and testicular cancers more routinely. However, cancers of the head and neck (not including brain cancer) cause many more deaths than those cancers. Over 640,000 cases are diagnosed each year worldwide with about 54,000 being diagnosed here in the US. Of those here at home, 13,500 deaths are due to head and neck cancer each year. The biggest reason why it leads to such a high death rate is because it’s usually not caught until the later stages which usually means it has spread or metastasized. I’m getting a lot of these facts from the Oral Cancer Foundation (http://oralcancerfoundation.org/facts/index.htm). Check out the site, it can give some other scary facts and some gruesome photos.
The point is that you need to be screened for this on a routine basis. Just like women get breast exams and colonoscopies are recommended, the goal is to catch it early so it can be erradicated from your body conservatively. Oral cancer screenings are a lot less invasive and not difficult at all. There are some devices out there that can help, but screening for oral cancer mainly involves using your eyes and your tactile sense. When I do an oral cancer screening, I begin by pulling out the tongue with a piece of gauze then look and feel the sides of the tongue. I look at the tonsils and the roof of the mouth, check the cheeks, feel the floor of the mouth and bottom of the tongue, then feel the gums around the teeth. Total time is about 30-60 seconds. I do that with every patient that has a hygiene appointment. You should be screened every 6 months especially if you are a smoker. This is why it annoys me when people say “it’s just a cleaning”. A good exam has the potential to save your life. It’s one thing to have a cavity, but it’s a whole other to possibly have cancer.
A couple of last points. Smokers and tobacco users are more at risk, but there are a lot of non-smokers that get diagnosed each year as well. There are a lot variables that cause cancer, smoking is just one of them. Screening and diagnosis are two different things. I am looking and feeling for abnormalities or lesions in the oral cavity, I am not diagnosing cancer. The only way to truly diagnose cancer is to biopsy the area and look at the tissue under a microscope. We would send you to an oral surgeon to have that done. If your dentist is not doing an oral cancer screening, you need to ask or find another dentist. If you’re still not getting a regular screening, come in to see me and I’ll do it for free. Lastly, doing a good screening on yourself is a little difficult, but if you see something that doesn’t look right or it hurts, go see your dentist. Especially if it’s been there over 14 days. Don’t think it’s going to get better on it’s own. Remember the best way to survive cancer is to catch it early.

So I’ve discussed dental insurance in our blog before, but one question that we get quite often is “Why are not on my insurance plan?” So I felt the urge to discuss this and rant a little, so bear with me. First off, dental insurance is a misnomer, it should be called dental benefits. Insurance, by definition, is designed to help in a catastophe. If you crash your car, you get it totaled or repaired (after paying your deductible). Your house burns down, the insurance company gives you money to rebuild your house. Dental insurance sure doesn’t pay for a full mouth rehabilitation if you’ve ground your teeth down flat and you’re now developing subsequent joint problems. That could cost $20-30K. What does “dental insurance” cover, around $1K depending on your yearly maximum. So dental benefits subsidize some of the cost, they don’t pay for dentistry. That’s the first point I want to make.
The second point is about “preferred provider plans”, aka PPOs. These are plans that your employer has agreed to be a part of. Many time this allows your employer to pay less for dental coverage. As a client of a PPO, you are encouraged by your employer and insurance company to go to a practice that participates in your plan (some insurance companies actually are quite forceful in their encouragement and make it sound like you cannot go to a non-participating practice).
So you have dental practices and clinics out there that accept pretty much every PPO that is available. From an outsiders view, why wouldn’t you participate in every PPO? But what a lot of the public does not realize is that in order to be a participating provider, you have to agree to set fees on what the insurance company decides. Well we all know that insurance companies make money by not paying out any more than they absolutely have to (see my post about end of the year benefits, “use ’em or loose ’em”). In order for a practice to participate with the PPO, the practice has to discount their fees 40%-60% in most cases. So why should a patient care about that? Especially if it means that you have to pay less for that crown.
A dental practice is a small business and it has bills to pay just like any other business. So if a practice has to discount their fees 40%-60% and still have those bills to pay, they have to make some choices. They can use lower quality/less expensive materials, not improve their dental equipment and facility, reduce staff, or see more patients. Most practices that accept those PPOs choose to see more patients. This means that you spend less time with the doctor, the doctor seems rushed, the staff is not as friendly (because they are rushed and tired), you are spending more time in the waiting room, and your dentistry doesn’t look as good as you want it to. It boils down to the fact that the customer service is not as good as it could be. And this is not true of every practice that accepts PPOs. We accept a couple PPOs that allow us to acquire some new patients yet still keep our quality at a high level. As a patient, you can save a little money by going to a provider that participates with your insurance that your employer purchased or pay more to get the quality that you are hoping for. It just depends on your lifestyle and your priorities. Obviously, I’m biased and do not like the insurance companies, but it always aggavates me when I see and hear stories about sub-par dentistry and the customer service provided. So thank you for letting me rant. Dental benefits can be confusing so if you have any questions, just let us know.

Well it’s taken me a week or so to get back to normal, but my Guatemala hangover is over now. While things are still fresh in my head, I wanted to post some of my experiences and lessons learned. First, I would like to thank Dr. Byron Henry, his wife, Stacy, and all my new Free to Smile friends for making it such a fun and productive trip. Just a brief synopsis of what we did. Both a dental and surgery team went on the trip, about 30 of us all together. Both teams went to the surgery center the first two days where we triaged the cleft lip/palate kids to make sure they were healthy enough for surgery. Then the dental team went out the next four days to some of the villages in the mountains to do extractions and fillings (even a handful of cleanings). Then the last day we came back together and did some relaxing and sightseeing (most of the sightseeing for me was about 400ft up on a zip line…awesome!)
The Guatamalans were very appreciative that we were there. And I could go on about the several hundred teeth that the dental team took out. And many said that we have changed their lives for the better and those experiences I had with those people were amazing. But I want to talk a little about the cleft lip and cleft palate surgeries. Those parents who kids had their cleft deformities fixed were the most amazed and appreciative. In the States, cleft lips and palates are things that are corrected within the first couple months of life, but in Guatemala, kids might not get those deformities fixed until much later in life. Speech problems, chewing difficulties, and negative social stigma can occur through the years. Some folks that live in the remote areas of Guatemala feel these kids are possessed by bad spirits or demons. So when the surgeons use their skills to correct these clefts, it really is an amazing thing. I posted a few photos here and on our Facebook page (search Distinctive Smiles of Dublin). You may be surprised to see the extent of the deformity.

This is why this work that Free to Smile is doing is so important. If you or anyone you know wants to help out with donations to even go on one of these trips, please let me know. It really is a great adventure!

As some of you know, in a couple days, I’m headed to Guatemala. Not for vacation, but to do some dentistry and hopefully help some folks that don’t have access to the privileges that we have here in the good ‘ol USA. A friend of mine, Byron Henry, who is an oral surgeon here in Columbus, started a non-profit called Free to Smile several years ago. Through the years, he has set up clinics in Guatemala, Columbia, Nepal, Cambodia, and Mali in Africa. His wife is the president of the company and between the two of them they spend a lot of the year out of country. They make quite a sacrifice being away from family, their friends, and Byron’s practice.
Byron’s passion for pro bono work is infectious and if you’re around him long enough, you would feel compelled to help. Through the years, I’ve been supportive through monetary donations and participating in charity events such as the annual golf scramble (of course I would be golfing anyway). However, I feel I’ve been very fortunate to be in the situation I am in and decided it was time to do a little more. So on Friday, I’ll be hopping on a plane to Guatemala.
I’m not the only one that decided to do a little more. There are four surgeons, four general dentists, and about twenty support staff joining us on the 9 day adventure. The surgeons will be doing cleft lip/cleft palate surgeries. These surgeries will completely change a person’s life. In a third world country, some view a person with a cleft lip or palate to be possessed by demons and evil spirits and they can be banned from their village or community. So when the surgeons complete a surgery like this, those people many times are welcomed by to society. It’s a very powerful thing. The dentists such as myself, will be seeing adults and kids doing things such as fillings and extractions. We’ll be headed to the villages and setting up rooms in churches and schools with portable dental equipment. I doubt that I’ll be talking too much about whitening and veneers.
My hope is that this trip will put things in perspective and to demonstrate even further how lucky we are to have the things we have. I posted several times back about our trip to Greece and how there dental system was not quite to the standards we have here. Well I’m sure this trip will also demonstrate those differences even further. My other hope is that we help people. It really is the reason why we all got into the healthcare field in the first place. These people do not have access to care and may have never seen a dentist. So we’ll see how they react to receiving care. Regardless, I’m sure they will be appeciative for any care that can be provided.
I’ll post again with some photos when I return. In the meantime, give someone you care about a hug and be appreciative they are in your life.

December was a crazy month here at the practice and at home so I needed to make a resolution that I post more often. But resolutions are difficult to keep. I find that if I don’t write them down and post them in a conspicuous place, that I don’t keep them very often. I also have found that I can only really count on keeping one or two. But I enjoy posting to our blog, so this one will probably be a little easier to maintain. I know a lot of people out there make a resolution to stay healthy or improve their health. I’m biased, but I think maintaining your dental health or changing your not-so-great dental habits would be a great resolution. So I’ll give you a couple ideas for some dental health resolutions.

1. If you don’t have a dental check-up scheduled, call right now. Pick up your cell phone and call your dental office. Start the new year with a committment to get on a recare schedule (whatever your dentist recommends-every 6, 4, or 3 months). If you already have an appointment, promise yourself to pre-schedule your following recare appointment. People are many times more likely to keep an appointment that they already made than to pick up the phone and call to schedule.

2. Change your drinking habits, especially if you drink sugary liquids. Did you know that if you put an extracted tooth in a glass of Coke that within 1 day the tooth will be dissolved? Between the acid and the sugars, soda is very destructive to teeth. Even more destructive, are the energy drinks that are out there such as Gatorade, Redbull, Monster, etc. They are more acidic and usually have more sugar than sodas. You don’t have to stop drinking soda or energy drinks, but try to not sip all day or drink them right before you brush (see below). I’d rather see a patient gulp down a can of Coke than sit at their desk, sipping on it. At least after a big acid attack, the saliva has a chance to neutralize the mouth instead of a constant flow of acid and sugar sticking to the teeth.

3. Rethink the philosophy of your brushing habits. Research has shown that brushing teeth less than 30 minutes after acidic foods is actually more destructive to the teeth than no brushing at all. This means that if you have a Mountain Dew, eat an orange, or throw up from the flu or partying too much, you should wait until the acid level goes down in your mouth. You can chew some sugarless gum (or gum with xylotol is even better), swish with some baking soda/water mix, or just wait, but don’t brush the enamel because the acid has caused it to be in a weakened state. If you were to time your brushing to be the least destructive, you would brush as soon as you get up in the morning BEFORE eating breakfast and you should brush when you get home from school or work BEFORE you eat. This lowers the amount of bacteria in you mouth that cause cavities and your enamel is not weakened from those acidic foods.

4. Start flossing or improve your flossing technique or buy an Airflosser or WaterPik. Take 1 minute of you day to floss just once. You can floss in the morning or at night, before or after brushing (although before is what’s recommended), and use any type of floss that feels comfortable. See my previous posts for good technique and other tirades about flossing. Also, something that is new to the market, but seems promising, is the Airflosser from Phillips (same people that make the Sonicare). You place the tip, push a button, and it uses a high pressured mist of water directed between the teeth. I’ve been trying one out for the past couple months and it does seem to work. Give me a call if you want more information or want to purchase one because I’m not sure if they are out in the stores yet.

Good luck with whatever resolutions you make. I hope they make you healthier and happier with your lives. And I hope you have a great 2012!

So the stereotypical dentist works four days a week and goes golfing the other three. That’s not a huge stretch for some of us (although I know several collegues who could not care less about golfing). A recent survey of dentists revealed that about 52% of dentists golf at least once per year and only about 18% play more than 15 times each year. For some of us, it gives us the ability to decompress from our careers, hang out with friends, compete, or just get outside. However, when you look at it a little closer, dentistry and golf have several other similarities that probably draw dentists toward the game.

1. Golf is used as a segway to business meetings because it can reveal more about a person than just a business lunch. Put a person in a dental chair and you may learn things that his/her friends don’t know.
2. Golf has many highs and lows. You can lose your composure after a bad shot, but have to figure a way to get back on course. When working with a human being and human teeth, things can go awry, but a dentist has to figure out a solution.
3. Golf is game played with others, but the final result is yours alone (your score). There are hygienists, assistants, and front desk employees helping the dentist, but ultimately the dentist is responsible for the end results.
4. A small number of golfers have to have the latest driver or game improving golf ball. A small number of dentists will be the first to own the latest piece of equipment or newest material.
5. Even the same golf course will present new challenges each time you play it. The dental practice and its patients will challenge the dentist differently each day.
6. Golf will test your patience. Patients will test your patience (our practice has very few that test our fortitude however).
7. Sinking a long putt, hitting a great drive or recording a birdie will keep you coming back for more. Cementing a great fitting crown, finishing a extensive treatment plan, or seeing your patient almost to joyful tears when they see their new smile; those are some of the moments that bring a dentist back each day.
8. No matter how good of a golfer you are, you always want to get better. One of a dentist’s top priorities should be to never stay satisfied and always improve his/her ability to provide the best care possible.

Let me give credit to the great writers of Dentaltown magazine for helping me with some of these insights. I suppose you could say the more golf I play the better my dentistry will be. If only my wife would believe that…

I don’t consider myself old, but I do have several years of practice in this career we call dentistry. So I hear the fears of my patients quite often. Whether it was a bad childhood experience of a dentist not using anesthetic or their dentist standing on the chair while they “yanked out my tooth”. I still can’t imagine a dentist doing either of those. However, the most common two things that patients fear the most are “the dreaded shot” and “the awful noise the drill makes”. Well many of you know that we have an anesthetic machine called the “Wand”. Instead of using the big silver syringe that you see in most dental offices, the Wand using a small plastic holder with a very fine needle. It controls the rate that the anesthetic goes in (pushing the fluid in too fast is what usually causes most of the discomfort). After we numb a patient, many say they didn’t feel anything. So many of our anxious patients are no longer fearful of getting numb. You can check out this youtube video that will show you what it looks like.

We just recently addressed the noisy drill issue. Older style handpieces or drills use air from a compressor to turn the bur. The loud pitched whirring noise that is heard is the air pushing again a turbine inside the handpiece. Well that noise is not only annoying for the patient, but for us as well. Not to mention that it’s hard on all of our ears. So we did some research and decided that it was time for something different. Electric handpieces have been out for several years and quite popular in Europe. But there were some drawbacks such as heat buildup which could damage soft tissue and lack of speed control in which it may take the operator longer to fine tune the tooth preparation. After researching the different electric handpieces systems, we decided to go with ones that not only address those issues, but provide minimal noise. The power and torque of these handpieces also allow us to remove decay and prepare a tooth in a faster, more efficient manner. There’s less vibration and fiberoptic lighting that allows me to see better. And did I mention that they are very quiet (I think I’ll be able to hear my grandchildren when I retire). You basically will hear the suction tip more than the drill. Check out this video which will show the difference between air and electric handpieces.

We’ve been using these for a while and patients have had very positive experiences. Obviously, we promote prevention and we only drill on your teeth in order to make you healthier. And when we do, our goal is for it to be as comfortable an experience as possible. So between the Wand and our new electric handpieces, we’re moving even closer to that goal.

As we draw toward the end of 2011, our practice makes it a priority to make sure patients realize what dental benefits they have remaining for the year. We’re always trying to explain dental insurance with patients throughout the year. The insurance companies try to make it as hard to understand as possible so patients are less likely to get the full benefit from their plans, in my honest opinion. And we fight with insurance companies to get every dollar the patient should get from their plans. Resubmitting x-rays and claim forms, writing narratives to justify reasons for sound, recommended treatment, and writing appeals for when insurance companies don’t pay what they said they would. Let’s face it, the insurance companies don’t make money by paying for claims so they do everything in their power to not pay. I could go on bashing the insurance companies, but after we jump through these hoops, they do subsidize some of the treatment costs and allow some patients to be healthier. But I still don’t like them…
The funny thing is that we (ie dentists) invented dental “insurance”. First, let me digress a little…it’s not really insurance. The definition of insurance is “to protect against catostrophic loss in which a third party payor guarantees coverage”. So if you wreck your car, the insurance company gives you a check for the totaled car. If your house burns down, your home insurance provides a check to build you a new home. Many of you know that most employers sign up most employees for dental “insurance” plans that give a maximum of $1000-$1500 per year. And if your in need of rehabilitative treatment (something beyond a couple fillings and a couple cleanings), your costs can be in the high four figures to 10’s of thousands. So the term insurance is not correct. Around here, we call them dental benefits because they subsidize the cost of most treatment.
So back to the story of dental “insurance”. We invented it back the late 1960’s and it was designed to provide coverage for the dental catostrophic event (accidents, trauma, extensive breakdown of the teeth, etc.). The coverage in the 1960’s was a yearly maximum of $1000-$1500, just as it is today. However, if we adjusted for inflation, today each patient would receive about $8700 each year in dental insurance. Notice I didn’t put that in quotes, because that could actually cover a castostrophic dental event.
Moral of the story is that an employee spends a certain amount out of their paycheck each pay period to have dental benefits. You might as well use them. We’re coming up on the end of the year so use ’em or lose ’em. Oh, by the way, that’s another way insurance companies make a bunch of money – people not using the benefits that they paid for throughout the year. I love dental “insurance”!

One of the things that I enjoy the most is taking someone’s smile that they have not liked for years and creating a whole new smile that functions well and the patients can be proud of. Patients have told me that this change has increased self worth, enhanced their professional lives, and given them the confidence to ask someone out. We take pride in the cosmetic dentistry that we can provide in our practice and our patients take pride in the new smiles that we have provided for them. These cases take a lot of work from my team and the lab not to mention the courage and investment from the patient to have such a change take place. Things such as porcelain veneers and crowns to long span bridges replacing several missing teeth can all contribute to creating a whole new smile.

Yesterday I had a junior in high school ask if I enjoyed what I do and if I would become a dentist all over again. Without hesitation, I emphatically said yes. You see I was the cliche that said I wanted to go to college to become a doctor, more specifically an orthopedist (fixing broken things has always fascinated me). Well the more I discovered about medical school and the healthcare system from doctors I shadows at the local ER, the more I wasn’t so sure. I came from a family in which my dad was a factory worker and my mom was a teacher and while they were very supportive, I didn’t have any family members that could mentor me in a healthcare career. I enjoyed science/health classes and I enjoyed working with my hands through woodworking, model building, and playing sports so a family friend told me to check out dentistry. So I volunteered at a couple dental offices, went to school and the rest is history.
So back to the teenager from yesterday. He was interested in a dental career so we talked about some of the things that may help him move toward that goal. I thought posting them here might be helpful to others looking toward that career path. One thing we discussed is visiting or working at a local dental office. Gaining first hand experiences will always allow you to discover and learn about a future career. It also allows you to network and get the word out that you are interested in this field. This is especially important when you are applying for dental school or looking at associate dental positions after dental school. There are many dentists out there who know each other through continuing education, discussion boards, and study clubs. The other suggestion is an obvious one. You have to focus and be driven to do well in school. Take opportunities to take AP classes especially in math and the sciences. Separate yourself from your classmates by getting good grades and being active in extracurricular activities. In college, whenever I felt I lost focus to get into dental school, I would go shadow the local dentist. I would watch the cool stuff he did and he would tell me how he actually liked coming to work each day. That would give me the motivation to push forward and achieve my goals.
Some people say they hate coming to the dentist and to them the dentist represents pain and discomfort (our practice puts a huge focus on minimizing any pain or discomfort so hopefully our patients don’t feel quite as cynical). However, the ability to make people healthy and proud to smile is what drives me each day. I’m not saying that it’s all flowers and rainbows every minute of each work day. But I have an opportunity to provide for my family while going to work each day with the anticipation that I can help someone feel better or improve their quality of life. That is why I would do it all over again. And I hope to have a long, fulfilling career with challenges and successes. So if you know a young person who is interested in a dental career, have them contact us. My staff and I love what we do and are happy to show a perspective dentist, hygienist, or dental assistant a real world dental experience.