The Year for Change
January 11, 2014
A list of New Year’s resolutions is really like a “to-do list” on a larger scale. As with many to-do lists, some of the items on it keep getting pushed down in the ranking of priorities because of the constraints of time. So I have a suggestion to keep in mind when making pledges to yourself about what you are going to do this year: Make purifying your time your first resolution.
Many driven people pride themselves on how many tasks and commitments they are able to take on. Eventually, reality catches up and this philosophy of always doing more becomes counterproductive, as you inevitably have to approach your growing list of commitments at a more superficial level. The simple truth is that getting more done is not a matter of doing more things; it is a matter of doing the right things with your time. In that sense, the answer is often found in “unhooking” yourself from the low-value time wasters that hold you back from giving your full attention to the things that truly drive your success.
You can’t buy more hours in a day, but you can reclaim time for yourself. You can choose to delegate; you can choose to streamline and purge yourself of recurring nuisances that eat away at your productivity. You can choose to say “no” to demands on your time that don’t fit your criteria for being worthwhile. By purifying your time priorities in this way, you amplify the value of your time and you get more out of life.
So as you put together your list of things you want to do over the coming year, be sure to work on another list at the same time: a list of things you don’t want to do anymore. Think of it as a “To-Not-Do” list.
Some of the items on this list may take time and effort to unhook from, such as delegating others to take over certain duties. Some of them you will find you can drop right away. Of course, this does not include things that you are passing on to say your spouse, like laundry and grocery shopping.
Be ruthless about it, keeping in mind that this is your most precious resource we are talking about. Examine each recurring demand on your time and ask yourself if it’s adding value to your life in an intangible way? Is it enhancing your productivity and improving your life? If the answer is no to both of those questions, the next question becomes obvious: Then why are you doing this?
Challenge yourself right now to sit down and create your own list of things to not do in 2014. Try to come up with at least five items. This is a great way to start the year with a feeling of liberation. This allows you to clear your mind of clutter and award yourself more time and energy to embrace the really important possibilities.
You can create specific lists for different aspects of your life, like your health. Changing your habits takes effort and the awareness that you want the change in your life. I look forward to sharing ideas on this subject throughout the year.
5 Reasons People Avoid the Dentist
January 20, 2013
There are five major reasons that people do not get the necessary dental care they need. They are money, time, lack of concern, fear and trust. Let’s take a quick look at each one and see if any of them fit you and what dentists often try to do to overcome these obstacles for patients.
Although you may think that money would be the number one reason people avoid ideal dental treatment, it is not. Even in these tougher economic times, money, although a significant barrier for many is still not the number one issue for most. Yes, dental care in some cases can be a significant investment. With insurance industry’s unwillingness to raise the bar, as I have talked about in previous columns, patients often get stuck with large dental bills. Unfortunately, as of now, we have to face these facts and it does not mean avoiding the dentist.
Many dentists offer payment plans through third party carriers so patients can pay for treatment over an extended period of time. Ask your dentist if they have such an option. The point here is to get a plan. Once a plan is established, your dentist can work with you to prioritize and sequence your treatment. This way, if you need to spread your treatment over a period of time to make it affordable, you can pick away at a well thought out plan.
Time is an excuse. We all use time as an excuse for many of the things in our lives we want to avoid or procrastinate on. The reality is however, if we place something high enough in our value system there is always time for it. But, in order to move something higher up in our value system, we must be educated and come to realize that this particular thing is of benefit to us. This brings me to the most common reason people avoid ideal dental care.
Lack of concern about dental health is prevalent with a huge percentage of the population for a few reasons. Absence of pain is one. Other than “nerve gone bad” need for a root canal, there few things that actually cause pain. Take for example periodontal disease. About 75% of the population has some form of this disease but only 50% of the population goes to the dentist. Why? No pain. This doesn’t mean it is healthy and there are not problems down the road like loss of teeth. It is up to the dentist to educate patients on these types of issues, but people have to actually go to the dentist to get this information.
Some people have fear of going to the dentist….and for good reason, due to bad past experiences or bad information. However, dentistry today should be a comfortable experience most of the time. For those who are still fearful, there are different medications dentists can use to ease the experience.
The last barrier to ideal treatment is trust. For a patient to move forward with treatment, it is essential the patient both like and trust the dentist. Although I am sure that the skills of your dentist are important to you, I am willing to bet that you would not stay with a dentist that you did not like or trust. Find someone you can connect with and build a strong doctor-patient relationship.
21 Suggestions for Success in 2013
January 3, 2013
If you are reading this column, the end of the world did not happen on December 21st and it’s time to think about the ways in which to improve our lives for 2013.
As readership has grown for The Town Common, I thought it was appropriate to re-publish this column so that new and old readers could benefit from this list. It is a great way to start a new year.
These 21 suggestions for success are authored by H. Jackson Brown, Jr. I have a framed picture of these hanging in my office and read them every day. I get comments about them all the time from people saying how much they like them. Cut this column out, hang it on your refrigerator and read it frequently.
1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that’s worthy of your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you’ll sometimes be wrong.
18. Stop blaming others even if it means you’ll sometimes be wrong.
19. Be loyal and courageous. When you look back on your life, you’ll regret the things you didn’t do more than the ones you did.
20. Take good care of those you love.
21. Don’t do anything that wouldn’t make your Mom proud.
22. (my own) Strive for optimal health……and that includes dental health.
Is Seeing Believing?
October 24, 2012
Last night I heard a commercial for a cholesterol medication in which the person playing the doctor says, “I wish my patients could see what I see.” I believe there are two ways to look at that statement.
The commercial showed an image of animated artery walls clogging with particles of plaque clinging to one another making the opening of the artery smaller and smaller. This is a visual that is easy to understand.
The second, and more subtle way to take this statement, is the doctor wishing that patients could see what happens to patients over time with and without compliance to taking medication or changing their diet. If patients could only understand and use the vast experiences of the doctor to make better decisions for themselves, wouldn’t everyone choose to do all the “right” things for a better and healthier life? Conventional wisdom would say “yes” but reality says something different.
I have been photographing teeth for over 18 years. When I tell a patient that I am going to take a series of pictures of their teeth the response I often hear is, “I just had x-rays taken.” When I explain that they are pictures and not x-rays it is not uncommon for the patient to ask, “Why?”
I had a new patient in yesterday for a consultation who said these exact words. The patient then said something that I also hear frequently, “No one has ever done this before.” My response is that I take pictures of teeth for two reasons. The first is for my own documentation and the second is to be able to show the patient what is in their own mouth.
Showing a patient visual images of their own teeth is by far the most powerful tool I use in practice. How many times have you been to a dentist where treatment is explained and recommended but you can’t see it? A picture is truly worth a thousand words.
When I started displaying the images and giving the patient above a tour of her own mouth the patient said, “Wow, that doesn’t look good. I can’t believe that is in my mouth.” I hear that a lot too. After the “tour” I continued to explain why things look a certain way and what to expect in the future. I proposed both long and short-term plans for the patient to consider. Photographs are invaluable for this exercise and most patients appreciate being able to see what I see.
The next part of my consultation is to try to get the patient to look beyond the pictures and envision where they want to be 5, 10, 20+ years down the road. My goal is to bring my own experience of knowing, based on all the patients I have seen in practice, where the patient is headed and give them the opportunity to potentially change the course of their future.
This approach may be different for some people. It is easy to get overwhelmed by any new approach and I always encourage patients that this is the beginning of a relationship and decisions to do or not do something do not have to be made today. My new patient said, “I am X years old and I don’t know if I am even going to be around in 10 or 20 years.” Crystal ball or not, it still seems like a long time to me.
You, as a patient, should look beyond today and make choices for ANY aspect of your health based on where you want to be in the future. Take advantage of the knowledge you gain from all your experiences and make decisions that you feel are right for you.
The Soda Ban
October 5, 2012
On Sept. 13, at New York City’s Mayor Michael Bloomberg’s urging, New York City’s Board of Health approved what’s believed to be a first-of-its-kind ban on the sale of supersized sugary beverages. In six months, if there’s no lawsuit filed to block it, containers of Coke, Pepsi and sugar-laden flavored drinks larger than 16 ounces will be outlawed at restaurants, movie theaters, food carts and sports arenas. Business violators would be subject to a $200 fine.
This ban doesn’t stop someone from buying two 16-ounce cups or bottles of soda. Nor does it apply to convenience stores or grocery stores. And, of course, New Yorkers are free to drink however much they want at home.
It is said that at worst, the new soda ban will inconvenience some hard-core soda drinkers. However, my contention is whether or not this is the right way to approach the war on obesity? Critics contend that this ban is an assault on our freedom to choose. I have mixed feelings on the subject. Does the ban on large beverages and the previous Bloomberg-inspired ban on trans fats lead to a ban on the number of hamburgers one can purchase at the same time?
Last week, the American Dental Association (ADA) gave a thumbs-up to Mayor Bloomberg’s initiative. ADA president, Dr. William Calnon said, “Health professionals, including dentists, have long stressed the importance of a healthy diet; yet obesity and lack of exercise — associated with chronic diseases and conditions such as heart disease, cancer, diabetes and hypertension remain high.”
On the ban itself Dr. Calnon said, “When it comes to a ban related to a particular food or beverage, is a stick rather than a carrot approach the best way to get people to adopt healthier diets? Perhaps not, but the attention alone that the mayor’s ban has generated on this issue is certainly a huge step in the right direction.” Dr. Calnon seems to believe that the attention to the subject is worth more than methodology. Most of us are aware that super-sizing anything is probably not in the best interest of our health. If we ban certain food products to fight obesity, should we make exercise mandatory?
As with any lifestyle choice, the lessons need to start early in the home. What we choose to buy in the grocery store to provide for our families on a consistent basis is the backbone of the impressions our children get, which will help them make better choices on their own. Our children need to grow-up in an environment where we respect what we put in our own bodies and take care of ourselves with exercise. It seems to me that banning or limiting what can be purchased is an attempt to make up for the lack of discipline in the home. But, will that work?
Is the limitation of allowing smoking in public places the reason for a decrease in smoking? Smoking in public places puts others at risk and is the main reason, but smoking in general has decreased because of the increased awareness of health risks. Does the ability to buy a 32-ounce soda have a direct effect on anyone surrounding the person buying it?
I’m all for increased awareness of what science has shown is good or not good for us. Armed with that information, we have the personal responsibility to make choices that we feel are right for us as individuals.
Spleep Apnea – Part 1
August 22, 2012
Why is a dentist writing about sleep problems? More and more dentists are getting training in this area of medicine because they can be of help in the treatment of some of the problems associated with sleep-related issues. There also seems to be a large part of the population who are un-diagnosed or are diagnosed but have issues with treatment modalities they are using.
Sleep problems need to be diagnosed by a trained professional. Although there are many dentists who are providing treatment for sleep apnea, there are certain channels to consider for proper diagnosis. For example, a sleep study is a must in diagnosis and a dentist alone cannot provide this.
What is sleep apnea? It is a serious, potentially life-threatening sleep disorder that affects approximately 18 million Americans. It comes from the Greek meaning of apnea which means “want of breath”. People with sleep apnea have episodes in which they stop breathing for 10 seconds or more during sleep. Since many people see their dentist on a regular basis, if there is any concern of sleep apnea, the dentist can work closely with a physician to implement and manage a prescribed therapy.
There are two major types of sleep apnea, both of which can severely disrupt the regular sleep cycle.
Obstructive sleep apnea is when the muscles in the walls of the throat relax to the point where the airway collapses and prevents air from flowing into your nose and mouth. However, as you continue to sleep you also continue to try to breathe. This is the most common type of sleep apnea.
Central sleep apnea is the other type. This is when breathing interruptions during sleep are caused by problems with the brain mechanisms that control breathing.
What are the symptoms associated with sleep apnea? People with sleep apnea usually do not remember waking up during the night. Some of the potential problems may include morning headaches, excessive daytime sleepiness, irritability and impaired mental or emotional functioning, excessive snoring, choking/gasping during sleep, insomnia, or awakening with a dry mouth or throat.
So, what is the difference between snoring and sleep apnea? Unlike mild/moderate snoring, individuals with sleep apnea stop breathing completely for 10 seconds or more, typically between 10 and 60 times in a single night. If the person sleeping in the same room hears loud snoring punctuated by silences and then a snort or choking sound as breathing then resumes, this could be sleep apnea.
Studies have shown that people with diagnosed sleep apnea can be so fatigued during the day that, when driving, their performance is similar to that of a drunk driver. If left untreated, sleep apnea can lead to impaired daytime functioning, high blood pressure, heart attack, or stroke.
Next week we will discuss the diagnosis of and treatment options of this potentially life-threatening disorder.
One Patient’s Story
July 25, 2012
This is the story about a woman I met recently named “Carol”. Carol’s story is the reason I do what I do every day and brings me back the next day. The interesting thing is that it has absolutely nothing to do with performing the actual physical work of dentistry.
Carol is in her 70’s and for most of her life has gone to the dentist infrequently. She presented to my office a couple of months ago for a second opinion. At our first appointment Carol brought her most recent x-rays, a treatment plan from another dentist, and a page-long list of questions. She was well-prepared for the complimentary consultation I was giving her and seemed to know exactly what she wanted.
About 8 years ago, Carol visited a dental office that touts itself as “holistic”. Carol had about $10,000 of dentistry done at that office and unfortunately had not seen a dentist since. Her reason for visiting that particular office was because she was/is very concerned about her health and believed that a “holistic” office could provide her with what she was looking for. Now, only 8 years later, her teeth were falling apart.
Carol had eight crowns done on her upper back teeth at that time. The crowns, still in her mouth, were failing due to recurrent decay. More importantly to Carol, her front teeth were in severe breakdown. Carol had her mind made up; she wanted full dentures.
Carol sought out a local dentist, presented her desires, got a written treatment plan with fees, and then came to me for a second opinion. She brought that treatment plan with her and it appeared very reasonable – take out all remaining teeth and place full dentures. The first thing I noticed was that Carol had 6 lower front teeth that have been decay-free and have had excellent bone supporting them for 70 years. However, her mind was made-up, she wanted everything taken out. She did not want to have to deal with maintenance of teeth any more.
Over the next two consultation appointments I had with Carol, we discussed many different treatment options. We thoroughly reviewed the advantages of keeping these lower front teeth each time we met. Carol brought a list of questions to each of these meetings, which we discussed in depth. It was decided – Carol was moving forward with full dentures.
We have had two more appointments since then. Because of the location of the dental laboratory that I use, those appointments were spread-out over a few weeks. At this point, we had done some procedural steps to get her ready for full dentures, but the teeth are still there. They would not get taken out until the dentures were ready to be delivered.
At each appointment I discussed a different aspect of why it would be such an advantage to her to keep those lower front teeth. Her mind was not changed. Yesterday, Carol walked into my office to tell me that she has decided that she wants to keep her lower teeth.
Okay, so what’s the point? The point has nothing to do with what Carol’s final treatment is. Carol has every right to decide on what she feels is right for her.
The dentistry Carol received 8 years ago was good technical dentistry on the teeth that were treated. However, the “holistic” dentist did not treat her as a whole person and left the rest of her mouth destined for failure.
The local dentist she got the treatment plan from provided a very reasonable treatment proposal. They had one visit, decided on treatment and her next step was to go to the oral surgeon and have all her teeth out.
Far too many times I see patients and dentists rush into treating teeth. Taking the time to engage in conversation and treat the person as a person and not a tooth is less common than it should be in my opinion. My point of this story is not that I got Carol to do what I felt was best for her, but that I gave her my time, answered all her questions, and allowed her to decide what was best for her. She needed the time.
There are few things we have to rush into in life.
Media Spin on Dental X-Rays
July 22, 2012
For the past couple of months, every dentist in the United States has had to deal (in some form or another) with the story on the front page of the Cleveland Plain Dealer newspaper entitled, “Dental X-rays Linked to Brain Tumors in Yale Study”. The story made national headlines, and why wouldn’t it with a title like that?
The reporter did publish excerpts from a meeting with ADA (American Dental Association) spokesperson Matthew J. Messina, DDS to get the dental communities’ perspective; however that was published on page A-4. As Dr. Messina explained, “Like a courtroom trial, the prosecution went first. Page 1 included the first six paragraphs of the article. The ADA’s defense was well presented, but after the ‘jump’ to page A-4. It required that a person be committed enough to understanding the story, to be willing to actually open the paper and read the article to the end. And that is one of the problems that ‘we’ will always face as a profession.”
For the rest of us who don’t live in Cleveland, or read the Cleveland Plain Dealer on-line, we got our story from the national news media. All I heard was that dental x-rays cause brain tumors. As a consumer and someone concerned about my health it raised an eyebrow. As a dentist I knew there was more to the story.
Here are the facts as presented by Dr. Messina:
How common are the brain tumors? (Six per 100,000) How did the researchers find a link between dental x-rays and brain tumors? (They asked people with brain tumors to remember how many x-rays they had over their lifetime) Is there a problem with this type of study? (Yes, it’’ called “recall bias”) Are dental x-rays different today than they were even 10 years ago? (Yes, the amount of radiation in current dental radiography is dramatically less than in years past) What should patients do with this information? (Talk to their dentist about any concerns so that their dentist can give them accurate information and reassure them)
While there is strong evidence that ionizing radiation may cause cancer, the question remains whether low doses lead to an increase in risk. Regarding dental x-rays, the effective dose is far below the yearly exposure received from natural background radiation. In the case of brain tumors, the cerebral (brain) region is not even in the primary radiation field of most dental x-rays. This was not even considered in the study.
Where do we go from here? If you are in the approximately 50% of the population that does not see a dentist on a regular basis, this information does not mean that much. If you are in the other 50% that understand that oral health means so much more than having your teeth cleaned or a tooth filled, I would recommend the ALARA rule (as low as reasonably achievable). Dental radiographs are a safe, essential and effective tool in identifying dental decay, gum disease, pathology, as well as monitoring proper growth and development.
As a society it is my hope that we are willing to move past the skimming of all the information that is available to us and ask questions when things relate to us. We (dentists) as a profession will continue to work towards educating our patients and providing the safest, most effective care.
Made in China
May 29, 2012
I just returned from my semi-annual journey to my dental lab in Georgia where I meet with a group of dentists who share both the laboratory we use and the passion for excellence in what we do. The topic of dental restorations made overseas came up. Mr. Terry Fohey, certified dental technician and owner of NuCraft Dental Arts, one of the finest dental laboratories in the country, believes that a dental patient should have the right to know where the materials are coming from that are being put in their mouth.
China and other countries can claim to use specific materials, but there are no regulations in place to verify the information. There are also no regulations that allow a dental patient the right to know where the materials came from that are being placed in his/her mouth.
With the help of a State Senator from Georgia, Mr. Fohey is proposing legislation requiring dental laboratories to disclose to the dentist the material contents and point of origin of every dental restoration. It would also require the dentist to disclose the information to the patient should the patient ask. Would it make a difference to you whether or not your crown was being made in the United States or not?
Why are some dentists and dental laboratories farming out dental restorations overseas? Like everything else in the world, money is the reason. I get advertisements in the mail daily of dental laboratories able to make crowns for ridiculously low prices. It apparently sounds enticing to some practitioners.
Wonder why some dentist’s fees are higher or lower than others for this service? There are actually many factors that go into the creation of a fee for a procedure that requires a laboratory expense. The patient never sees the laboratory expense in most cases because it is built into the total fee. Clinical experience, clinical skill, office overhead, time required, and nature of the practice are all things that go into the creation of a fee.
The cost of the laboratory procedures also greatly affects the cost for the dental procedure. Let’s take crowns for example. I have seen laboratory fees advertised as low as $39 per crown and know of other dental labs whose fee is a few hundred dollars per tooth. Some patients would accept a lower quality product going into their mouth for a lower cost and others would not.
There are even machines you can buy that can fabricate crowns while you wait. There are many choices. It is basically up to the dentist to decide what he/she feels is in the best interest of the patient based on knowledge and skill.
In my experience, laboratories that cost more tend to make a better product. That better product which gets put in your mouth is a direct reflection on the dentist placing it. Excellent lab work, however, does not make up for less than perfect clinical skills. I have been in practice for 16 years. It took me a good 7 years to find a laboratory that meshed with what I try to accomplish for my patients…..and believe me, it was painful getting there.
We live in an ever-changing world. I try to buy American as often as possible, but realize that it is not always feasible. Mr. Fohey summed it up this way, “This bill is simply about disclosure. It does not restrict anyone from importing dentistry. Instead, it just makes us all play by the same rules.”
