Fluoride. Friend or Foe?

One of our patients came in the office just the other day and asked me whether or not I was in favor of fluoridated water. The patient happened to be a millennial and she was very concerned about her children and the potential complications with the use of any prescription level medication. This is an interesting question and is not without political intrigue so therefore I thought it might be the good subject of a blog.

When I was at UCLA School of Dentistry in the early 70s my epidemiologist instructor Dr. Serene (a great name for a dentist) was very much involved in the fluoridation of public waters.  In fact he was the lead researcher involved with the first fluoridated water project ever in the United States on the east coast in the 50's and 60's.  Because he was my instructor at a very formative age I obviously took his opinion very seriously.  However, my clinical group director Dr. Janette had what I consider the best answer to any question regarding the use of prescription level fluorides.  He was a clinical dentist and his comment whenever asked was something along the lines of, "when you get a cold, you take cold medicine.  You don’t take cold medicine if you don't have a cold.  If you have cavities, you take cavity medicine.  Cavity medicine are fluorides."  I believe to this day even with all the ups and downs of the use of publicly fluoridated water Dr. Janette's comment is the most accurate.  Children and older adults that have cavity issues should be on prescription level fluorides and we prescribe those for them on a routine basis.  We have applied fluoride here to children topically as well as older adults for sensitivity and many other reasons.  However, the use of systemic fluorides can certainly be made complex by the use of publicly fluoridated water.  How much fluoride do you ingest when you cook with it?  If you bathe in it and wash with it, exactly how much of it are you ingesting? These are complex questions that are difficult to quantify and make prescribing personal systemic fluorides difficult to answer.  So my question back to the patient was are you most interested in my opinion regarding Elk Grove or National issues?  She indicated that she was most interested in our and her family's area. And in my opinion that is once again is fraught with politics and complications that involve the Elk Grove area that was I will discuss in my next blog.

The Cruise

Well our 86th trip since 1984 is now history.  This was our 3rd staff morale booster in 2015.  The first one was our adventure for a full day of fun at Great America and a private tour of Levi Stadium the next day.  We had over 70 people participating, by far the most of any of our trips,  The 2nd was the 4th of July trip to Lake Tahoe at a property call the Ridge in Heavenly Valley Resort.  The trip included fireworks, hiking, and certainly a lot of beach/water sports.  This latest trip was a week long Princess Cruise of California and Ensenada, Mexico.  We had over 30 staff members and family for fun in the sun on the ocean and beaches of California.  The highlights were numerous but maybe the best was one of our spouses winning over $1400 in the casino and securing a full alcohol drink card as a bonus.  Other notable experience may be one of our hygienists learning to live with a family of 5 in 140 square foot cabin set up for 4.  Or how about one of our staff members learning to live with her 2 year old grandchild along with the rest of her family in that same size cabin.  All in all, I believe from the start, with the Blue Angels and Fleet week send off, and cruising under the Golden Gate Bridge at sunset, to getting back to home sweet home, this was another expense well spent.  

OSHA Part 2

Part 2 of this GHS discussion involves the current changes from Hazcom and how it affects the dental offices on a day by day basis.  First, we need to replace all of our MSDS forms with the new GHS SDS forms safety data sheets.  As I mentioned in Part 1, there are pictograms involved with the new SDS forms that have to be supplied to us by the manufacturers.  Interestingly enough, the compliance portion of the new regulations went into effect in 2014, and yet the Government in all of its wisdom mandated that the manufacturers do not have to supply us with the new SDS forms with appropriate pictograms until the end of 2015.  Therefore, in the meantime we continue to illegally use our old MSDS forms and have been in non-compliance until the final date given by the Government of June 1, 2016 for the manufacturers to comply.  I am sure you can imagine that due to cost considerations the manufacturers will not be supplying us with any SDS lists until the last minute which has been our experience thus far.  Hopefully, by the middle of next year we will have the new SDS pictograms and we can switch over to the SDS forms along with all the labeling that goes throughout the office where any of the hazardous chemicals are kept.  Now you are probably thinking that this is not a particularly big deal but to put it into perspective.  We have at this time over 300 MSDS forms in our binder that is a whole heck of a lot of labels that we have to print out and post in the proper area.  In the meantime, our current labels will remain and I suppose as long as you can speak and read English and live in the United States it is not a real big problem except the fact that you are at risk of not being informed and we are violating the OSHA regulations.  If all of this seems a little scary you do have to understand that our MSDS forms include things like our hand soap, Lysol spray, rubbing alcohol and a variety of other household chemicals that we use in the dental practice.  It is interesting to me that we have to label household materials in our office and you don't at home but that perhaps points out the relationship of Big Government and small business in America.  We are hoping for the best and maybe by the time you come in for your next appointment you will be able to see our nifty little pictograms on the walls.  See you at our next blog.

In Memorial

I wanted to take a moment to let all of my readers kn ow that my family suffered a huge loss a few weeks ago on my wife's and my 43rd anniversary.  Our lifelong companion and dear friend Pudge passed away while trying to get to the vet for emergency treatment.  Pudge was almost 13 years old and was diagnosed by her cardiologist with a cancerous tumor above her heart two weeks ago and given only a few months to live.  Unfortunately, her cancer was not treatable either by surgery, radiation or chemotherapy, thus we knew her time with us was limited.  Unfortunately, as many of you know, I have been blessed with a photographic memory which has served me well in Dentistry but it is torture for me now seeing Pudge laboring for breath as she passed away in Karen's arms over and over again.  Pudge was the alpha female of our family and ruled over our other four Corgi's even at the very end of her life.  You had to respect her tenacity, brashness and ability to bring a smile to the face of anyone she met.  Her demeanor was equally exquisite with infants, toddlers, small children as well as geriatric patients at care centers.  Karen and I often wondered how we were blessed with such a wonderful companion.  She was truly one of a kind and we miss her terribly.  She left her paw prints on our hearts.

OSHA Part 1

If it seems like I pick on the Government a lot in my blogs, you are probably right, but I feel that they pick on me even more.  One of our hygienists, who has been with us for over 20 years, has often made the observation that Government makes new rules just to see if I will continue to comply or just give it up.  I have always considered it a badge of honor to be in full compliance and so it will remain.  As for this blog it is about the new OSHA (Occupational Safety and Health Administration) regulation.  Most of you are aware of OSHA's primary obligation is to prevent evil bosses like myself from inflicting pain and suffering upon our employees.  In dentistry, OSHA covers both blood borne pathogens (infection) and hazardous communications of chemical hazards, Hazcom. There is a major change in OSHA at this time and Hazcom is the change. It is called GHS or Globally Harmonized System.  You will have to forgive me but whenever I see that term it reminds me of an old Coca Cola commercial, “I like to teach the world to sing in perfect harmony.”  This change from Hazcom to GHS has been occurring in stages over the last few years due to President Obama’s obsession with globalizing the economies.  His feeling is that since we live globally and our hazardous chemicals are sold abroad that we need to be able to communicate their dangers to people that don’t speak English and cannot read our MSDS (Material Safety Data Sheets) forms.  Therefore, he has adopted for us the 1998 United Nation's GHS rules regarding pictographs.  You know those little triangles with pictures of skulls and cross bones, flames or explosions printed inside of them.  These would be included with the English dialogue of hazards of spills, contaminations, etc (Gee, I wonder if the EPA has these kinds of labels on their spills in the Colorado rivers recently.)   Needless to say there is a huge amount of paperwork involved with all these changes.  Our old Hazcom, which used to be 28 pages long, now is over 100 pages long, and our very thick binder of MSDS forms will have to be replaced completely with the new SDS (Safety Data Sheets).   In any event, we'll discuss the importance of all this in my next blog, OSHA Part 2.

Your Donation Changes Lives!

Practicing dentistry for almost 40 years in Elk Grove with our large family of patients has put me in what I consider the unique position of observing a huge number of heartfelt personal stories.  Some of those stories I have already shared with you in previous blogs, but one very special story came up just the other day that I thought I should once again share with you.  One of our special needs patients came in with a wonderful story of his participation in the Special Olympics a few months ago in Los Angeles.  He had the singular honor of being picked to be a torch bearer for the opening of the games.  His only disappointment was that he could not actually participate in the games even though he had trained very hard in several events.  That is because as a torch bearer he could not compete as the organization tries to benefit as many people as possible.  Thus torch bearers cannot compete. Rest assured, he didn’t complain about it at all.  He was just thrilled to be a part of the whole gathering of wonderful people.  Now this patient has been with our practice for over 13 years and takes remarkably good care of himself with the help of his family and tremendous support of friends and the Special Olympics organization.  We have on many occasions had the opportunity to support his efforts both financially and with moral support and guidance.  But he is the one that deserves the special recognition for all of his tremendous efforts.  In speaking to him the other day, he would like nothing more than to have the support of our family of patients to help Special Olympics in any way that you can.  Please go to their web site and see what you can do to help this very worthy cause as it helps special needs patients like ours to be an active participant in our society.  After all this is what makes us who we are as a great country, a caring society, and very giving individuals.  Thank you in advance for all of your help and we look forward to many Special Olympics to come. Your Donation Changes Lives!

HIPAA Part 2

Time for our 2^nd chapter of the HIPAA saga.  As we left it last time, George Bush signed the High Tech Act into effect in 2002 and you would have thought that was the end of government intervention into our protected health information (PHI).  But that would be too easy.  The Office of Civil Rights (OCR) has continued to tinker with the privacy portion of HIPAA over the last 13 years, to the point that Congress felt obligated to pass the Omnibus Bill in 2013 which was signed into law by President Obama personal healthcare information.  So we are very restricted on who we can give out PHI to including even spouses, children and parents.  For example, we had a patient call up a few weekends ago with the need for antibiotic medication for a dental infection.  She was not feeling well enough to drive down to the office so we could dispense her the medication and she wanted to send her husband or her sister, who lives close by, to pick up the antibiotics and pain medication.  Unfortunately, since we did not have a signed HIPAA release for her to either her spouse or sister we could not dispense the medications for her.  In addition new FDA restrictions do not allow us to call in the medications to a pharmacy without a signed release form.  All the prescriptions now have to be handwritten out by the prescriber completely and picked up by the patient when the pharmacy does not have a signed release on file, HIPAA again.  Fortunately, she was eventually able to have someone drive her here to pick up her medications, but what a mess!  Does it really need to be this complex? Or is there some reasonable ground that we could offer privacy, but reasonableness.  By the way, the official list of definitions in the Omnibus bill is almost 20 pages long and we do now currently in our office have 14 different signature forms for your protected health information storage and dissemination requests.  As the definition of family, that government form is over 2 pages long.  If this seems like overkill, it probably is.  But leave it to the government to protect your personal identification just like they did for the over 20 million Federal employees that had their information hacked from Federal storage.  The take away message must be protect yourself as best you can and hope for the best.  After all, as my father told me, we live in a free country, not necessarily a fair one. 

HIPAA Part One

I have been spending many many odd time hours at the office recently.  It's not so that I can provide the best quality dental care to our large family of patients, but rather on reviewing new government regulations that affect my practice, as well as the practice of all of my peers and of medicine in general.  That acronym is HIPAA, which stands for the Health Insurance Portability and Accountability Act.  You will note that there is no word privacy here.  That is because that is not the reason for the law as it was written in 1996.  History shows us that the bipartisan law was proposed by Senator Ted Kennedy and Nancy Kassebaum and sent to President Bill Clinton for his signature in August 1996.  The reason for the law was a concern for what was termed “job lock” and the insurance coverage of pre-existing medical conditions.  In addition the government set about the process of trying to save money by verifying the portability of dental insurances.  There was also a mandate for fraud and abuse in the law and administrative simplification provisions which they thought could save the government somewhere between 3 or 4% in administrative costs for Medicaid and Medicare.  Yes, it is all about the money.  Then there was a provision in the law, put in the last minute, for privacy.   Kennedy and Kassebaum realized that there may be a problem with electronic transfer of data between insurance companies and the government and they assigned a mandate for congress to resolve this privacy issue within 3 years.  As you can expect, by 1999 they had not fulfilled that mandate, and the job was turned over to HHS (Health and Human Services) who established OCR (Office of Civil Rights) to write the privacy laws which came out in November 1999.  The document was 300 pages long and was released December of 2000.  In the “final regulations” they mentioned 265 times the term "reasonable" in trying to make the privacy laws appear to be easy to manage.  The final guidelines were released in July 2001.  But by then there were modifications of the Notice of Proposed Mandates that came out in March of 2002 which went into effect in October of 2002.  This eventually led to the forms that you sign at our office today, the “Notice of Privacy Provisions” and our “good faith effort” in getting you that information.  The unfortunate thing about this process is really the privacy portion of the law really boils down to a few short words “we get your PHI (personnel health information) from you and we should not give it to anyone without our permission.”   Unfortunately those few words translated into thousands of pages of documents from the federal government that we need to evaluate and respond to with hundreds of pages of documents of our own and many many hours of time.  All this is based on the goal of saving the government 3% on this cost.   How much does that cost us in the medical field that is passed onto you the consumer?  I am not sure,However I am sure it is much more than 3%.  I will review the next phase of HIPAA and its current status in my next blog beginning with the HITECH Act (Health Information Technology for Economic and Clinical Health) and the finally the Omnibus Bill passed in 2013.  

A History of Weather Patterns

I have been an observer of weather patterns for many years going back to my days at UC Irvine when friends of mine and I did a little weather study and challenged the local NBC affiliate and their anchor people Tom Brokaw, Bryant Gumbel and Kelly Lang their weather person to a little contest.  We ended up winning the contest, having rather simplistic weather models as our guide.  Since that time there is a general concept that the United States has had some really bizarre weather patterns.  Since 1992 (the start of our current global cooling pattern) we have experienced some of the most costly hurricanes and winter storms of the century, worse flooding in the history of the Mississippi and Missouri river valleys, one of our coldest winters and record breaking heat and droughts in the west.  The question is, what is making the weather change?  Is our weather becoming actually wilder?  The answer, according to those in the know, is that the weather is not becoming wilder.  The charts, grafts and histories show that the USA has long lived with floods, hurricanes, tornados, dust storms, blinding winter storms and droughts.  Nothing we have experienced so far signals that a long term change is underway.  Usually the worse weather is spread over decades.  Sometimes however the worse weather is drilled into a few years.  The 1930s was such a time, followed by a long calm.  Perhaps it is because we have gone out of a calm, the relatively quiet 70s and 80s, that weather we currently are having seems so foreboding.  Also during those calmer times we forget about the lessons of harsh weather.  In known hurricane alleys we replace old fashioned beach houses with million dollar homes and after a flood people often rebuild in flood planes with the hope that floods like those of the past won’t happen in the future (take North Natomas for example.)  When the inevitable storm comes and destroys again the monetary damages can seem astronomical.  Many of us in the west think of “wet” years as being normal and normal years being considered dry.  Past weather records and other kinds of less direct evidence show that what people may consider a drought has occurred many times in the past sometimes lasting scores of years that may be actually normal weather.  A hurricane that hits an area that has not been hit in 20 or 30 years or floods exceed those of the past few years or drops in an area that has unusually wet years for several years people start thinking the weather must be getting worse.  But is it the weather or our ignorance of it? As we enter into our next wet season the forecast seemed to call for El Nino and substantially heavy weather patterns.  Hopefully, we are not ignorant of the potential for flooding and that our government officials will be very cautious about where they allow new housing to be built.  In the meantime, at our office when we did our remodeling almost 10 years ago we updated the building to withstand 140 mph winds and 8.2 earthquakes.  In addition when the building was first built the floor is actually 9 inches higher than the highest flood waters ever recorded in the city of Elk Grove going back to the 1850s 100 years before Folsom lake was built.  So I think we will be able to weather whatever storms mother nature decides to bring our way.  Hopefully you will be able to stay high and dry also and will not suffer the follies of the past.

Good-bye to an Implant Innovator

Christmas time 2014 was a sad time for those of us who regularly restored dental implants.  The innovator of the osseointegrated dental implant passed away.  Per-Ingvar Branemark died at the age of 85 of a heart attack in his home town of Gothenburg, Sweden.  The interesting trivia is this development of dental implants was basically an accident.  At the start of his career Branemark was studying blood flow affects on bone healing in 1952.   As part of this study he was encased in embedding titanium into the legs of various mammals and when the research ended he went to remove the titanium devices and discovered that it had fused to be bone and could not be removed.  He called this process osseointegration and at that time his research took on a totally different direction.  Interestingly enough, wanting to broaden his test subjects he actually enlisted 20 students working in his laboratory to have titanium instruments inserted in their upper arms.  Apparently every male in the laboratory was considered a volunteer and many of them have scars to this very day.  But even after years of experimentation it was difficult to convince the medical and dental establishments that titanium could be integrated into living tissue.  The conventional wisdom that the introduction of any foreign material into the body would inevitably lead to inflammation and ultimate rejection.  Dr. Branemark was further challenged in his work and at lecture in 1969 he was challenged by one of the senior academics of Swedish dentistry who referred to a Reader’s Digest article involving Dr. Branemark saying, “this may prove to be a popular article but I simply do not trust people who publish themselves in Readers Digest.”  As it happened, that senior academic was also well know to the Swedish public for recommending a particular brand of toothpicks, so Dr. Branemark immediately rose up and struck back saying, “I do not trust people who advertise themselves on the backs of boxes of toothpicks.”   Following that, the United States Institute of Health financed his projects and in the mid 70s Swedish National Board of Health and Welfare approved Branemark's implants which would therefore replace the implant systems that I learned at UCLA in dental school in the early 70s, which were blade implants and subperiosteal implants, which were often prone to rejection, which is the reason for the distrust of Brandenmark's research.  The turning point came in 1982 in Toronto where he finally won wide spread recognition for his materials and methods.  His dental implant system is currently sold by Novel Biocare, a publicly traded company, but there are many many different implant suppliers in the United States at this time.  I personally restore more than 6 brands of implants from different surgeons.  In addition to dental implants, this research has gone a long way to provide the millions of people with other osseo integrated replacements.  So even if you are not a dental implant patient, you may have an artificial hip or knee, then you should take a moment to thank Dr. Per-Ingvar Branemark for his help in resolving your complex medical needs.  Thanks again Dr. Branemark we miss you and our prayers go with your family.

The Economy of the Tooth-fairy

For those of you that are tooth fairy fans, I thought you might find this information interesting.  Guess what, the tooth fairy left an estimated 255 million dollars underneath pillows in 2013.  A recent survey, “The Original Tooth Fairy Poll,” has found that tooth fairies' average gift amount has hit a record high, averaging $4.36 per tooth in 2014.  That is up 25% from $2.50 in 2013.  Obviously reflecting a change in our economy.  The poll surveyed 1000 parents and found that in 40% of homes the tooth fairy was more generous if it was the first tooth that had been lost, leaving an average of $5.74 for the first tooth, a 27% increase from 2013.  The survey reported that in US homes the tooth fairy visited 81% of homes with children who lost a tooth, and that in 88% of those homes, cash was left for children either by itself or in combination with other gifts.  Kids who received gifts most often got a toothbrush, toothpaste or dental floss.  As for the reasons behind determining how much is left for each child, 44% of parents reported it was the amount of spare cash they had on hand while 39% based the amount on the child’s age.  By the way, not to be too political but if you feel that your government may be coming too intrusive, you might be interested to know that if your child comes in to our office or any other dental office with a permanent tooth eruption problem in which we have to remove a baby tooth, in order for us to give your child their baby tooth for the tooth fairy, Congress had to pass a specific law allowing us to give your child the extracted tooth, as the new EPA requirements no longer allow medical care providers to give their patient's bio-hazard materials that have been removed (gall stones, etc.) and this includes baby teeth.  Fortunately Congress in their “wisdom” is allowing us to give the child back their baby teeth.  If you want more information about poll results you can go to http://www.theoriginaltoothfairypoll.com and get more information.

                                  

The Vaccinate Debate

Wide spread use of vaccinations of our children, and more recently adults, has been a “hot topic” on the news lately with the spread of a measles outbreak from my old hang-out, Disneyland.  Obviously Disney has nothing to do with the outbreak.  The park is only a place where lots of kids hang-out, some without the vaccine for measles and others who are contagious with the measles virus.  Vaccines for deadly diseases have been used extensively since Dr. Jonas Salk developed the polio vaccine in 1952 and Albert Sabin licensed the oral vaccine.  As a child we all got the sugar cubes with the polio vaccine on it thus eventually eradicating the deadly disease with only 223 cases worldwide in 2012.  My mother was a registered nurse and when one of the other kids in my neighborhood got the measles, mumps, chicken pox, etc, she made sure that we went down to their house to play with him so that we would get exposed, and thus be immunized as an adult.  With that as my history I find the news coverage regarding the measles outbreak to be interesting.  The 170 kids in California with the measles outbreak would have been matched on my block alone in the 50s with all the moms exposing their kids when “Johnny” got the measles.  Today there is definitely controversy with the possible side effects of vaccines (including Autism) possibly caused by a mercury based preservative called Thinerosal that has been removed from all vaccines since the late 1990s. There are many studies that show that these concerns regarding side effects were always unfounded, yet the rumors persist.  There are also religious and moral obligations to the very nature of vaccinations.  To comment on that aspect is well beyond my pay grade.  However I will say that if you are making a choice for your child, remember that you may have to deal with the consequences as a parent if your child is the one that gets the disease if he or she is not vaccinated.  Please carefully consider the risks, benefits and alternative treatments (RBAs) closely before making your decision to vaccinate or not to vaccinate your child.

Like Us On Facebook

Social media seems to be taking over the world today including dentistry.  Just look at our office.  We have changed our name in part due to the influence of social media.  We see it every day here with our Facebook check-in gifts and other Facebook contests, our posts on Instagram and our new website. We see patients using their mobile devices constantly while waiting for x-rays, examinations, even to the point where they are playing internet games while they are having dental work done.  But the one app I have the most fun with is the selfies that patients take when they are undergoing treatment.  One that comes to mind specifically occurred the other day and it was the oldest patient that we have ever had take a selfie to post on Facebook for her great granddaughter. She is 85 years young and was not sure how to operate her  iPhone so I had Autumn help her take the photo and post it for her great granddaughter on her Facebook account.  It was a riot and so much fun.  By the way did you know that Facebook founder and CEO Zukerman’s father is a dentist in Long Island and that he lectures nationally on the influence of social media in dentistry.  But that is a story for another blog.

That's My Job!

Just in case you all missed it U S News and World report recently did their annual review of the best occupations in the United States this year, 2015, and the #1 job is dentistry.  Yes, that’s my job!  U.S. News and World report says dentistry offers “a comfortable salary, low unemployment rate and agreeable work/life balance.”  Dentists also topped the publication for this best healthcare occupations.  In fact Dr. Richard Balachovic, President Chief Executive Officer of the American Dental Education Association, is quoted as saying, “today’s students want it all and dentistry really does deliver that.  What other profession allows you to care for patients, make a good living and work as part of a team and have flexibility.”  Dr. Gerard Kugel, editor and chief of Inside Dentistry, says, “I agree that dentists do more than just treat teeth.  We diagnose dental and medical issues and if we do our jobs correctly we improve the quality of life for our patients.  It is a career that is rewarding both financially and personally.”   US News says that the flexible work schedule and low unemployment rate of dentistry also helps propel them to the top spot of the top 100 jobs in the U.S., which includes business, creative, construction, healthcare, social services and technology professions.  They listed the 4 following reasons for choosing dentists as #1: a low unemployment rate, a decent work/life balance, good salary and they predicted employment growth of nearly 16% between 2012 and 2022 with more than 23,000 new openings.  In short can there really be a better job than #1?  I don’t think so.  That is why I remain a dentist and am loving every minute of it for the last almost 40 years.  If you know anyone that is interested in getting into my profession, I would be more than happy to talk to them.  Just give me a call so I can help steer them in the right direction.      

  

The Reasoning Behind Staff Trips.

One of the discussions that our hygienist always seem to be having with our patients when I walk into to their treatment rooms for examination is about our last or next trip.  A frequently asked question from the patient is “how do I get a job here.”  Well first of all it is not that easy.  The hygienist who is cleaning their teeth would be one of our 5 hygienists that have been here for over 30 years, 25 years, 18 years, 15 years and 10 years.  That is relevant as the average career span of an auxiliary in a dental office in our area is 3 to 5 years.  And in fact, the average hygienist only works as a Registered Dental Hygienist for 5 to 7 years before changing careers.  So waiting for a turnover in our office is not a way to get a job.  That is the reason that I pay for the trips.  It is all about stability and camaraderie between our staff members.  It started in 1984 with our first trip to Hawaii for the Hawaii State Dental Society meeting in Honolulu Oahu.  I purchased the typical 5 day $399 per person package with hotel and air fare.  The 7 of us went and had a great time.  But the one thing that the staff asked is on the next trip could they bring spouses?  I thought about it for awhile and decided we would do what we could to make it happen.  In planning the future trips obviously we had to keep in mind that all of our staff have different financial constraints so I have always striven to make the trips either all inclusive vacations or condos in resort areas so there would not be any extra financial burden for the staff.  84 trips have come and gone over the last 31 years and all have been great successes.  This year our spring adventure was an all inclusive Great America trip and a day long private tour of Levi Stadium.  This was an alumni trip with four retired staff members and their families joining us which made for our largest group of 73 people.  The 4^th of July trip is to Heavenly Valley's The Ridge over Lake Tahoe and our winter retreat is a Princess cruise with balcony rooms for couples and inside cabins for families.  While some may say this is an extravagance, I cannot disagree more!  The trips allow the staff and their families to come together outside the office and form bonds that last for years and it makes for a much better working environment.  For proof, the next time you come here just look around at talk to our staff about how they feel about their work.  After all, don’t you want to have medical care providers happy with their jobs.  Doesn’t it work out better for you? Isn’t it worth it?  I think so!

                                  

"Is Dr. Gjerde still here?"

It is becoming a regular topic with patients as to why I have not retired yet.   After all, I am turning 65 years old this year and lots of my peers have already gone to the greener pastures of leisure and retirement.   The question reminds me of a discussion that I had with a patient years ago.  We were discussing a recent trip my wife and I had made to Los Angeles to visit her parents and brother and so I could attend the California Dental Association meeting in Anaheim (by the way, have you ever wondered why the Anaheim Convention Center is directly across the street from Disneyland).  Since Disney’s California Adventure had just opened along with the Disney Grand California Hotel we decided to stay there.  It worked because I am such a Disneyaholic and then we could commute to my in-laws' house in Downey.  Our conversation was about what I was doing while Karen visited with her parents and that question has stuck with me for years.  She said, “I certainly hope that since you were at Disneyland you left out time to have fun.” my response was, “you don’t understand the Dental Society meeting is fun.”  Interestingly enough, it still is just as exciting and as much fun as it was when I was in dental school at UCLA in the early 70's and my wife and I were newlyweds.  Now the kids are gone, and it is just Karen and I along with our 5 dogs; Pudge, Bell, Crush, Tucker and Bolt, and two horses (a topic for a later blog).  While I love my family I also love my work as it has been a huge part of my life for over 40 years.  Thus I just can’t leave my huge family of 4,000 current patients and 15 staff members.  I will obviously be here for quite a while.

In Memory of Mickie Baker.

I am here to tell you a little story about Boulevard Family Dentistry.  It's a question that I am often asked about and that is our large clock in the window of the front of the building.  I view it as our Elk Grove version of the "Back to the Future" clock tower.  Our building was built in 1974 by one of our patients and a builder.  He called our building his "little bit of Paris in Elk Grove” due to the masonry roof and the brick façade that he placed on the building.  The building went through a couple of different owners, all of which were my landlords, until the building was sold to Mickie Baker.  Mickie Baker traveled extensively worldwide and loved to bring back items of interest.  One day when she was in Belgium, she fell in love with a little clock shop that made hand crafted clocks.  She had them fabricate a custom window clock for her “little bit of Paris” and she hung it up in  the window on her side of the building, which is currently the hygiene side of the office.  Before she passed away in 2000, she rented us the entire office space and had me place the clock on our side of the building.   She made me promise that I would always maintain her beloved clock.  After I purchased the building I made it my goal to  grant her last wish.  Despite the fact that we have remodeled the building to update to current American Disabilities Act standards, and we lost the French masonry roof and the brick work across the front, I have kept my promise to Mickie as you can see whenever you drive by.  The clock is still there keeping accurate time for whomever passes by, maybe Michael J Fox in the Delorean.

Finding the Perfect Shade.

There are several differences between men and women in dentistry, many of which I have blogged about before.  However, one was brought to my attention the other day which is very interesting.  In case you didn’t know 7% of all men are colored blind, while only 0.4% of women are.  That is interesting as color blindness is encoded on the sex hormones and therefore many women are carriers but are not color blind.  But how does that interesting anomaly affect dentistry?  Well in my case, I am part of the 7%.   Specifically I can’t see many blues and reds.  Well let’s say I was doing a porcelain crown on your upper right central incisor and we need to match the shade to your upper left central incisor exactly.  When the laboratory technician is stacking the porcelain they use blue shades to mimic the translucency that many people have in their incisal edges of their central incisors.  Well if I can’t see the blue I can’t tell if the incisal edges match and it could look perfect to me but in actuality it is way off.  This is probably made worse with the fact that many teeth have orange or red tinges which I also cannot see.  Well, there is technology to the rescue.  We have used electronic shade matching computers for several years that can actually map several sections of your tooth to come up with a precise shade match on every portion of your tooth.  Is it perfect?  No, but with the help of an experienced and qualified laboratory technician we can get the shades really really close. And by the way, who are the best and most talented as techs at the laboratory to check shades?  Women of course.  Good Luck with those colors!  

Hi-tech

High tech is all the rage and it does affect dentistry.  If it weren’t for computers, iPhones, tablets and the internet, where would we all be?  Some love it, and others hate it.  I assume the difference is whether your “toys” are working or not.  But these are really more than “toys,” they have become part of our everyday life.  The one thing I have learned over the years however is that there is a place for technology, and other places where the old tried and true methods work better.  For example when my kids were little and they got a new hand held calculators that were available at the time, they thought that they were great.  But I would constantly drive them crazy by doing mathematics calculations on my old slide rule faster than they could push the buttons on their calculators.  Now to be honest, I have not used my old K + E Log Log Duplex slide rule for some years as I have learned to use computers just as they did.  But I believe the concepts of old versus new is still valid.  Now what does that have to do with dentistry?  I am sure you have heard advertisements for a new process in which they can do crowns (caps) in one visit.  It utilizes digital scanners, that we already use (Itero), with a milling machine attached  These offices can mill a new crown out of a solid "block" on the spot without having to send the impression off to a laboratory.  This means not having to deal with temporary crowns and need to return in a few weeks for a second appointment.  Sounds great doesn’t it?  But as always there must be a catch, and indeed there is.  You can only mill certain materials and today those materials fall into two categories.  The first one is one of the new “super composites” which are basically hardened plastic tooth colored filling material.  The second material is a new ceramic material called E-max, which does look great, but is not nearly as durable as many of the other materials that we have used for years.  Therefore, especially on the molars, you are risking cohesive failure of the material in a single visit crown just for the convenience of avoiding a temporary crown.  I don’t know how you feel about it, but I don’t like Novocaine shots that much.  So redoing a new crown because it broke is not my idea of fun.  Therefore, although we use the latest technology for scanning images for crowns, until the manufacturers develop new "blocks" with a wider range of restorative materials, in my opinion milling a crown on site is not the best option for the vast majority of our patients, especially on their molars, which take a tremendous amount of force and are prone to mechanical failure.  I will watch for continued improvements however and will jump on the band wagon if possible.