Crazy Government

Life is a dynamic process that constantly changes and is definitely full of surprises. I thought I would continue to be a dentist/small business owner for the rest of my life. Make no mistake about it, if it was my choice that is exactly what I would do. Enter the government and guess what they have another one of their crazy new regulations and once again it is time to tear out one of my few remaining hairs. This time it is Occupational Safety and Health Administration (OSHA) having a lovely time changing the rules of worker’s compensation insurance. In case you were not aware of it and there is no reason that you should have been. OSHA as of 8/10/16 has instituted a new regulation regarding worker’s compensation insurance (29 CFR 1904.35(b)(1)(i)). This new regulation does not allow for standard drug testing for employees that have worker’s compensation related injuries. The government feels that it is discrimination for employers to mandate that their employees be drug tested with worker’s compensation claims because it is possible that the employee would not file a worker’s compensation claim with a work related injury for fear of being outed for the use of illegal recreational drugs. I don’t know how you feel about it but if a bus or truck driver is illegally taking drugs and gets into an accident and several people are injured or killed I would want to know about it. If for no other reason, then to prevent this person from continuing to threaten the public. This is just another one of those crazy government over reaches that I complained about on numerous blogs. Being a business owner and a dentist they have been getting too much from me. Hopefully in the near future I will be able to be a dentist only and give up all the government hassles.  

Flood

I came to the office 2 weeks ago at 6 AM, which is my usual time on Friday morning, and was surprised to see that our parking lot was a little wet which is certainly unusual as we had not had any rain for some time, but it did not give it a lot of thought. When I opened the door I could hear water rushing. I went over to the hygiene side and found about 2 inches of water on the floor. It was a broken pipe underneath the faucet in our hygiene room #4. I was able to get the water shut off underneath the sink and by 8 AM I was able to broom the water out the hygiene door and mop up all the extra water. I felt that I had done a really good job and we saw all the patients the rest of the day. However, by the next day the laminate floor was buckling up so much that we were unable to close doors completely. I knew we were going to be in for a major bill so I called TDIC (The Dentists Insurance Company) our dental society is self-insured insurance company. I spoke to a representative about 9:30 AM and they sent out their adjuster by noon that same day with a contractor that was supposed to be doing the repairs. After the asbestos and the lead testing was accomplished at 1:00 PM we got clearance to proceed with negative test results by 4:00 PM. The next day all of our floors and sub floors were gone along with 2 feet of sheetrock and most of the hygiene side. They placed in the fans which is normally associated with drying these things out 2 days later they were installing new sheetrock, tape and texture and a couple of days later they installed new sub floor. We are now at 2 weeks the entire hygiene side and the front desk office has been repainted and we have an office full of new flooring that is climatetizing itself to our facility. The flooring contractor is going to be coming in starting this PM and hopefully by Tuesday all the new flooring will be completed and Edison and I get to spend Wednesday AM putting the hygiene rooms back together again. I want to personally thank our fantastic staff and patients who have been very gracious in working around our construction zone and to Donita specifically who has been in charge of design of our new hygiene area. Hopefully the rest of the process will go as smoothly as it has gone so far. Boy it is great to be an optimist.

Microsoft

It is fairly late in the evening tonight and I am working on my presentation for our annual HIPAA update for the staff coming up and I was updating our risk assessment for catastrophe recovery under HIPAA. We actually have six backups for our computer. We have mirrored hard drives on our server, we have what is called a NAS which is a solid state drive which backs up our server every minute which is actually 2 hard drives in it, which are also mirrored. We have a remote storage facility at McClellan Air Force base in one of their secured buildings for the old Military base that is backed up every night and then we have encrypted cloud storage making for a total of six back up procedures so that your personal health information is secured and recoverable in case of a catastrophe. As I am working on this it reminded me of an old engineering joke that my father told me a few years back. The story goes that there is an engineering conference and as with most conferences all the engineers are staying at a local hotel and they have to go to the convention center and they are transported there by a convention bus. So these 3 engineers get up in the morning and go down and get on the bus. Before they reach the convention center the bus breaks down and the first engineer jumps up says I am mechanical engineer I know this is a mechanical problem I have my tool bag right here I am going to go out and fix it. The 2^nd engineer jumps up says I think this is an electrical problem I know how to fix it he grabs his tool bag and runs off the bus to go fix it. The 3^rd engineer is a Microsoft certified engineer and he is simply sitting in his chair and yells out at the other engineers don’t go to all the trouble this is a computer problem everyone just gets off the bus and gets back on the bus and starts up and we go on to the convention. Obviously this is meant to be an extreme version of the story but it is part of modern society and the reason that we have six backups for recovery of all of your protected health information which includes obviously all the documentation of all the different procedures that we have done on you. Hopefully we never have to use any of our catastrophe recovery tools and we can just ride on the bus over to the convention center without having to get off. See you at our next blog.

Periodontics

I had the unique experience the other day of having a meeting with the periodontal group that we do most of our referrals with. Capitol Periodontal Group came by the office for a meet and greet. Most of the senior members of that group which I have been working with for the last 40 years have retired. Dr. Angel, Dr. Roberts, Dr. Hogan were some of the original owners. The 2^nd generation,Dr. Lane and Dr. Berrin have retired leading me to the 3^rd generation of seniors in the practice. Dr. Towfighi and Dr. Pretel. I had not had the opportunity to meet several of the younger members of their group (the 4th generation), so Dr. Towfighi said he would bring over some of the members to my office for lunch. I was shocked when everyone came. There was a group of 10 of us all sitting around talking about the differences of the new procedures in Periodontics. One of the topics was the new LANAP procedure which stands for Laser Assisted New Attachment Procedure. They reviewed the procedure with me and as one of the comments that I heard was that it is the “Holy Grail of periodontics” because it actually allows new bone to generate and new gum tissue to generate around infected and periodontally diseased teeth. This puts into question one of my periodontal instructors at UCLA, Dr. Takie, whose favorite phrase was  “you show more or have them no more” which means that you did gum tissue reduction to eliminate periodontal pockets in order to save your teeth. That process can lead to substantial issues associated with post-op sensitivity and additional decay problems. The new LANAP procedure however allows patients to avoid all these issues. This is obviously a new procedure it has only recently received FDA approval in 2015 and so it will be interesting to see how valuable this process is. The reason that I am mentioning all this is we have a large number of patients that I think can benefit from this process and so don’t be surprised if you hear our hygienist mention it. Hopefully it will truly become the “holy grail” and we will be able to save a lot more teeth.

Government Regulations

In my mind, there is no question that government continues to intrude on our lives more and more. Whenever we have a new patient come into the office, because of government rules, we have to electronically sign all the different forms that the government requires us to have. These are primarily part of HIPAA, the Health Insurance Portability and Accountability Act. And although it may seem like a pain in the neck, they are the government's way of protecting us from ourselves. Often times I will have patient's comment to me about the number of forms they have to sign and I relate to them that it is similar to buying a car or buying a house or signing that crazy contract with Apple when they are upgrading our software. These are forms that are drawn up by a team of attorneys you never really want to read, but it is probably better for you if you do. In our particular situation when the patients get a little frustrated in signing the forms my comment to them is usually the same, “the government will protect you from everything ill that will ever happen to you,. All you have to do is sign away all of your rights and give them all your money.” That is meant as a joke, but the way things are going it really seems like there may be a lot of truth in saying that. It certainly will be interesting to see how our next presidential election works out in November.  It will definitely give us some indication as to the direction that we are heading in our country. In my opinion, hopefully government does not get any more intrusive than it already is. By the way, having reached Medicare age I'm wondering how I managed to survive so long.  

Stress Test

One of the best aspects of aging is that you see life in different perspectives over a period of years. After doing dentistry for 40 years I have certainly seen a lot of interesting things that primarily has brought me great joy. However, getting old comes with a cost. One of those costs, interesting enough is having your wife yell at you about getting a cardiac stress test done. You know that when you go to the doctor and they put you on a treadmill and increase the speed and inclination to get your heart rate up to see the overall condition of your heart. I got the pleasure of participating in a stress test a few weeks ago after having my wife yell at me for a number of months about it. I went to the doctor’s office the cardiologist checked my medical vitals before I got started and then she gave me over to the technician to perform the stress test. There are 7 levels to the stress test I did get through 5 of them with my heart rate getting up to over 180. When we were on the 3^rd level I noticed that the inclination was starting to get to me a little bit so I asked the technician if he ever had anyone pass out while taking the stress test. He indicated that very morning he had a patient go into cardiac arrest while doing a similar stress test. Fortunately, with the cardiologist right there the patient did survive but it did certainly make me wonder about my own mortality and perhaps gave me a little bit more desire to perform well on the stress test. Interesting enough the technician came in a couple of days later as a new patient to our office and we were reminiscing about my adventure at his office. I am anticipating that his adventure in our dental office will be as much of a success as mine was at his and not like the other guy's.  Hopefully I'll see you on my next blog.  

Old sayings

It is time to continue my "old sayings" blogs. This time it is 1972 UCLA School of Dentistry's Dr. Jennet. He was my group director and practiced dentistry for years in Portland, Oregon. He retired and I was blessed to have him as my clinical instructor for my 4 years at UCLA. Based on his experiences in private practice and at UCLA he was able to observe dentistry from several different angles. Thus his wealth of old sayings was substantial. How about one of my favorites first “Dentistry is not expensive, Neglect is.” That is even more true in 2016 than it was in 1972. If you want to "feel good" you need to take care of yourself, and that includes your teeth! Don’t ignore your symptoms is what Dr. Jennet was trying to get through, if you do it will cost you time, energy and probably a lot of money to fix a problem that should never of occurred. To that end old saying #2 comes to mind.  “You only have to floss the teeth you want to keep.” What he was saying is also part of his old saying #3, “there is nothing better for you than a little appropriate oral hygiene.” Obviously, Dr. Jennet like myself, lived and breathed dentistry. But I firmly believe he did not like being in the dental chair any more than I do today. Which leads me to his 4th saying “dentistry is like Christmas, it is better to give than to receive,” You have to admit he did have a weird sense of humor. See you at my next blog.

Life's Mission Statement

Almost 15 years ago I came to the conclusion that our government’s efforts to control every aspect of our life was becoming so oppressive that as a small business person it was impossible for me to keep up with all new government regulations.  We opted to hire a staff outsourcing company called Staff Resources who would handle all of our human resources needs and essentially I would be “leasing” my staff from staff resources. Jo, our HR representative from Staff Resources, was in charge of general supervision of our practice. She instilled in me the necessity of equal treatment for everyone in the practice. I could not play favorites with staff members. I had a close working relationship with staff members. We have worked with this concept for many years and it has serviced us well which brings me to the reason for this blog. In contemplating this concept of fairness for all I came up many years ago with my life’s mission statement so I thought I would write it down and it has been in my file ever since and I thought I would now blog it.

 My life’s mission statement reads “I believe that I have a responsibility to be a good person by that I mean fair, honest, hardworking and honorable. If I do that, if I am good to my family, fair to my staff and patients, true to my friends. If I give back to the community, if I am not a liar, a cheat or a thief then I believe that should be good enough. At the end of the day if there is indeed somebody or presence standing there to judge me, I hope that I will be judged on whether I lived that true life and not whether I worshiped a certain “God.”

 Even though I wrote this many years ago, I believe it is as true today as when we first hired on Jo from Staff Resources to verify that we are “fair” to all of our staff. See you on our next blog. 

Digital Radiographs

We at Boulevard Family Dentistry have been using panoramic x-rays for 24 years to help us diagnose an extended range of potential oral conditions.  These were originally done with analog x-ray film which we ran through an x-ray processor.  That was a great process but had certainly many limitations.  We converted our panoramic x-ray in 2002 retrofitting it for digital x-rays that substantially lowered our patients x-ray exposure levels and improving the image quality.  To take that to the next level, we opted to replace our Gendex panoramic x-ray with a brand new state-of-the-art Orthopantomograph OP30 digital panoramic x-ray unit.  It provides us with many upgrades which benefits us as diagnosticians and the patient with increased diagnostic capabilities.  For the patients that means radiation exposure that is half of what it was with the analog machine.  A total of 10 seconds exposure compared to 20 seconds, that is more that 4 times better than the old analog pano.  Our patients with severe gag reflex or large tori or fearful young patients, the new panoramic x-ray offers external bite-wing radiographs for diagnosing cavities with no x-ray film in the mouth.  We can do temporomandibular joint targeted exposures for better TMJ dysfunction diagnostic capabilities and we have state-of-the-art image quality.  This leads us to a win/win situation for the patients, staff and for our diagnostic capabilities.  We will continue to strive to update our office with the latest state-of-the-art techniques and equipment as always trying to give the best possible care to our large family of patients.

Breakdown

Many many years ago I had a patient that we had been seeing for a number of years who obviously shall remain nameless. She had a tooth that had been bothering her on and off for some time and was very unreliable about keeping her appointments. The tooth got to the point that it failed and I addressed the issue of this failure with one of my good friends the owner of Endodontic Associates. I addressed the issue in a letter and he wrote me back the following letter “thank you for your letter dated 3/5 regarding your patient. I think your letter summarizes the probable causes of the sudden periodontal breakdown nicely. Periodontal therapy as you know can maintain teeth for many many years but for some teeth in spite of ongoing care may cross an age or wear and tear threshold that leads to a change for the worse in their periodontal health. Fractures are definitely a common cause of this type of periodontal failure some periodontal issues develop suddenly and others build up gradually. A change like this with periodontal breakdown is analogous to the physiological change that can lead to a heart attack in spite of the ongoing care to prevent such an event. I suspect that the perio breakdown associated with these 2 teeth was severe enough that I had some doubts regarding the ability to successfully treat them.”  I have kept this letter for many many years in my desk because I firmly believe it is indicative of how we perform our jobs. We try to do the best we can every day but I am not God I am a dentist and sometimes things just fail. It is unfortunate when it happens to you as it did to this patient many years ago but sometimes failures just occur and despite our best efforts to prevent them. These are some of life’s learning tools and I believe we can benefit from all of our life’s experiences whether positive or negative. 

Circle of Life

Being a Disneyholic can have its positive and negative aspects and the one that comes to mind for me most recently is the movie, The Lion King in which there is a substantial emphasis on the “Circle of Life.”  I have had that occur to me and my family several times in the very recent past.  I recently returned from Los Angeles where my mother-in-law who is 98 years old is getting Hospice care at the end of her very long life.  That same week Dr. Naten’s wife gives birth to a new little baby girl, is this the “Circle of Life” from The Lion King? In that same time frame we had a terrible tragedy in my household.  My 15-year-old Morgan horse passed away suddenly due to a rupture of his abdomen into his thoracic cavity which was untreatable. In accessing our sudden loss Karen and I decided it would be best to rescue a mustang from the Bureau of Land Management, who was destined to be euthanized. Once again, part of the “Circle of Life”. These types of situations certainly give me pause to wonder about our place and how we fit into the grand scheme of this “circle of life”. It probably is not dental but I find myself taking a lot of time to contemplate these issues and to appreciate our time together with friends and family as I hope all of you do. Thanks for reading my blog.

My Father's Sayings

I have had several staff members ask me to spend some time writing down some of the sayings that I use all the time when dealing with a variety of patient issues. Many of them have been refined over a period of years but the vast majority of them are based on my life’s experiences both with my family as a child and with my substantial experiences in dental school. With that in mind, I thought I would do several blogs regarding some of those old sayings. I think I will start with several of my father’s old sayings who was an engineer and not a dentist but several of his sayings are applicable to dentistry.

The first one and probably my favorite is that “You pay for the inadequacies of your youth as you get older.” This is very true in dentistry.  If you have cavities when you are young and you have to have fillings done, most likely you will eventually have to have additional restorative procedures accomplished on those teeth as you age. If you have gum problems when you are young those will definitely haunt you in older age as your ability to heal decreases and gum problems become more progressive.  This reminds me of the 2^nd saying which was “the Lord wastes good healing on the young as they don’t appreciate it”.  Once again, if you have gum problems when you are young the healing capabilities that you have as you get older decrease and periodontal problems increase. You can certainly deal with this problem with great oral hygiene but it is always going to be an issue. The next quote which I oftentimes find humorous and I relate a patient at least once a day was my father’s comment to me “Mark, you can have one or two things in life. You can either have children or almost everything else you ever wanted.”  Fortunately, my father and mother picked children otherwise I would not be here. I chose children and I think for our future children are an extremely important portion of our lives and the future of our country. I will be doing more quotes from my father and from my dental school experiences in future blogs. See you in my next blog.

Let's Face It, Being a Dentist Isn't Easy

Make no mistake about it, I love my job.  I have been doing it for over 40 years and hopefully anyone who has done a job for 40 years really loves it.  However, let's face it, being a dentist is not easy.  You are not just running a small dental practice, you are running a small business which is also your families' livelihood.  You are running a small business that requires you to stay-up on all the latest procedures and techniques, hire and fire staff who are an extension of you and your business, all in the effort to improve the lives of your patients even though they don't really want to be in your chair.  It is a tough gig that is demanding and can be draining.  Between the government and its companies, I spend about 40% of my time making them happy.  I came out of dental school wanting to help people have a better smile and better oral health, yet we battle every day with patients that don't want to come in and some days it seems like I care more than they do.  In addition, as with every small business we have staff who don't exactly get along and patients that think I act too much like Steve Martin in "Little Shop of Horrors."  It is an interesting profession in which I have to hear several times a day "it is not you doc, its just that I hate dentists."  Fortunately, I really love my work and I look forward to it everyday, coming in and dealing with all the nuances of a modern dental practice and I plan on doing it for years to come.

See you at my my next blog.

Tooth Fairy Part 2

In our last Tooth Fairy blog I indicated surveys regarding how much the tooth fairy leaves children in the United States. Since the average in 2015 has gone down 24 cents from 2014 to $3.19. This would be the 2nd consecutive year the tooth fairy has reduced what she leaves under pillows. Surveys found that 32% of respondents reported that $1.00 was left by the tooth fairy the most common amount while nearly 20% of the respondents said the tooth fairy left $5.00 under their pillows and 5% of the household reported that the tooth fairy left $20.00 or more. On the other end of the spectrum 10% of survey respondents said their child received nothing from the tooth fairy. Interesting enough comparing moms to dads, the survey found that for the 2nd year in a row fathers reported to be far more indulgent as the tooth fairy, saying she left nearly 30% more than moms did, $3.63 versus $2.87.  Additionally, if you take it down by regions in the northeast of the United States 25% of the children received $5.00 or more while almost 10% got $20.00 or more bringing the average amount in that area to $3.56,  substantially higher than the overall national average. In the Midwest the tooth fairy left an average of only $3.13,  while the west got $3.09 and the south $3.07.  All this is obviously extremely interesting from my perspective. There are certainly differences in the way different parts of the country view tooth fairy issues and it is certainly something interesting to ponder. Hopefully with improvements in economy the tooth fairy can reverse this recent trend of decreases time will tell.

See you at my next bog.

Corperate Dentistry

Since graduating from UCLA in the mid-70s I found Dentistry going through many transformations as far as its delivery of dental care to our patients. In the 70's there was a fear among all private practitioners that HMO style insurance would take over (similar to Kaiser.) That never occurred.  HMOs are still in the 5-6% range of overall Dental Services in our area, primarily PMI for the state, which is a division of Delta Dental. The current challenge in Dentistry is corporate dentistry or DSO's or Dental Service Organizations. These large corporate practices have huge money backing them up and can provide services at decreased costs, but not without risk. While almost every one of my graduating class dreamed of owning their own practice I do believe that percentage is drastically lower today for a variety of reasons and one of them is corporate dentistry. Many of the corporate players are offering different financial packages and continued education opportunities. They are finding ways to reduce staff and doctor turn overs that plagued the industry in the past and corporate dentistry will continue to grow over the next several years because of what I believe are 3 primary reasons.

11.      Generational differences between myself and the new graduates. There are happy just “working for the man” and getting their paid holidays and benefits. They value their time off and do not dream of creating their own “empires.”

22.      My class only had 3 females out of a class of 106. At UCLA in Dr. Naten's class 3 years ago, it was 60% female. Because of differences between men and women dentists which I have blogged about before, women desire to work part time only, for family reasons compared to male dentists and therefore there is a complication in buying their own practices compared to their male counterpart.

33.     Lastly, the debt load of current graduates can be $300,000.00 compared to the $50,000.00 debt load that I had in the 70s. While this may be consistent with the increased costs of housing in that same time frame it certainly is a daunting factor in setting up your own practice.

These three factors will  undoubtedly help corporate dentistry to continue to grow over the next several years.  Hopeful for all of us at private practices, its growth will be limited, and not affect the way we provide services for our patients.

OPPS!

To all you bloggers!  I just had a patient in today that reminded me why they call my job "Practicing Dentistry".  We did a fairly minor tooth color filling on this patient’s lower right bicuspid to replace an old broken silver filling.  I placed the new filling with no apparent problem but he called up about a month later complaining of recurrent pain with the very same tooth.  He was going to Maui next week and wanted to have it looked at ASAP.  An X-ray quickly showed the problem.  I had a margin problem between the teeth on my brand new tooth colored filling.  Now this reminds me off an old saying of Dr. Jennet's, my operative instructor at UCLA in the early 70's.  One of his favorite sayings was, "The only dentist that never had an overhanging margin, is the dentist that never did a filling."  Much to my dismay, it actually took me 2 additional tries to get the margin down on this extremely interesting situation.  Relying on our radiographs to verify the edges.  And that is indeed why they call my job "Practicing Dentistry."  You never know what is around the next corner or where future surprises may lay.

Dynamic Duo

The other day we had a long time patient “visit” for the prep and impressions of a new crown on a tooth he had broken. He humorously noted that he looked forward to his visit to see how the “dynamic duo” was doing. I rarely have patients come in for treatment with such enthusiasm and friendliness. He obviously made Edison’s and my day. Edison is originally from the Philippines and came to us here in Sacramento after transitioning with his family on Oahu for five years. He then ended up here in Elk Grove. He is actually a dentist in the Philippines and due to the educational cost for retraining here in the states he opted to continue serving the public as an extremely confident RDA in our office for the last 14 years. In a field where most of his contemporaries are female he stands out as an outstanding example of a caring and sympathetic RDA. In fact, in our office of 19 staff members Dr. Naten, Edison and I are the only males which is not typical for most dental offices. However, the way we work together it’s probably the reason for the dynamic duo compliment. We all strive to do the best that we can for our patients and do dentistry to the highest quality standards possible. And with that thought in mind, Edison and I as a "dynamic duo" will go on to service our large family of patients and I do feel that our new name is a compliment of the highest order and we really appreciate it. 

Lifetime member

There are many advantages to getting older.  One of them is my natural parks senior pass (used to be called the Golden Eagle pass which I liked the name of much better) that allows for free access to all natural parks, forts, monuments, etc.  Next is probably all those senior discounts that you see at restaurants, shops and other retail outlets that provide me with anywhere from 10 to 20% discounts on services.  The next in line would have to be my new Medicare card that covers my health insurance costs.  It was something that concerned me quite a bit but my health insurance costs dropped by over 80% by going onto Medicare.  Certainly a nice financial surprise, but the most important asset for getting older for me personally is that I just received the attached letter from the American Dental Association.  It indicates that I have been a member of the Dental Society for 40 years and have turned 65 years old, so therefore I am now “Life Member.”  To put that in perspective, the SDDS, the local component of the ADA has over 1,400 dentists and only about 20 of them are life members.  It says in the letter “when you receive your life member pin please wear it with pride.”  I will definitely do that and the next time I see you at the office I will be wearing my life member pin, as I do believe it reflects my many years of work to prove the dental health of our community. In addition, I no longer have to pay my membership dues which is once again a nice financial advantage for getting older.  See you on my next blog.

Why Solar?

Many of you will have already noticed that we have solar panels on the roof at the office and you might be thinking that I have “Gone Green” despite my previous blogs regarding climate change.  Actually, that would not be correct.  I am a firm non-believer in global warming as I stated before.  I believe there are variations in our climate that are definitely not primarily caused by man/made issues.  Mother nature is the one who controls the planet for us visitors and in 10 million years (a blink of an eye to Mother nature) we will all be gone and she will still be here doing her thing without us.  Instead, the reason for our solar panels is primarily financial.  While most of you that have residential SMUD service you pay between 11 and 12 cents per kilowatt hour our rates can be almost 30 cents a kilowatt hour.  That leaves me with a $1000.00 a month SMUD bill pretty much all year round on a building that is approximately 3500 square feet.  We have already completed many title 24 processes to try to decrease our bills, like our R-58 attic insulation and new HVAC unit.  Therefore, it is now time to hop onto the solar power band wagon to cut our costs. We use the Sacramento county Ygrene program for financing so I can get the tax credits as well as writing off the financing in order to make the project affordable.  I would not say that the process is been devout of challenges.  But I firmly believe that it will pay off for itself in the end. As for those of you that are contemplating solar I do agree with my SMUD advisor that chasing pennies with dollars is not a great idea. Do everything you can to save energy costs prior to attempting solar. You would be surprised how high efficiency appliances or insulation, new HVAC and windows or shade trees, etc. can cut your bills.  But if you do decide that solar is the way to go, shop around there are tons of suppliers and a huge variation in prices and features.

See you at my next blog.

What I Like to Do the Most

It is interesting I oftentimes get asked what procedure in dentistry I like doing the most.  That question reminds me of an old friend and college of mine, Gordon Christensen who practices in Provo, Utah.  He lectures internationally and is very well know among the dental community.  I was at a symposium he was giving several years ago and he was talking about dentists versus physicians.  The average physician/surgeon does approximately 12 different procedures.  And if you think about it for a moment, he is right!  There are no more Orthopedic surgeons anymore.  There are knee doctors, hip doctors and elbow doctors but no people that do all the different orthopedic procedure.  on the other hand, your local primary care physician at Kaiser does not really do a lot of different procedures at all.  Primarily, he or she probably prescribes medication for you if you need it and refers you to a specialist if a specific procedure needs to be done.  That is because in the physician world 95% of the physicians are specialists.  On the other hand, in dentistry, 95% of dentists are in family practice like myself.  The average family practitioner in dentistry does approximately 144 different procedures.  So the question is a reasonable one.  What is the procedure I like doing the most?  I have given it a lot of consideration over the years and actually the better question is what procedure do I like doing the least?  As I thoroughly enjoy all 144 different procedures that I do.  The answer to that question of what I like doing the least the answer is obvious, working on people when they are not numb!

Do I favor Fluoridated Water. Part 2

This is the 2^nd blog on fluoridated water.  Going back to our discussion of fluoridation of public water supplies Elk Grove is special.  When I first began my practice here in the mid-70's we had a population of approximately 3000 and the Elk Grove water district was supplied by 4 to 5 wells depending on the time of the year by a family owned business.  Once Elk Grove grew to its current size of  over 150,000 the family operated business could no longer support the water needs and so the business was taken over by the city.  Still there was not enough water available, especially for the areas in Laguna (attached to this blog you will find the map of our fluoridated water areas).  The problem is that Elk Grove community water district does not fluoridate the water but does not have enough water to supply all of our residences.  Therefore, many times of the year the district purchases water from Sacramento city which is fluoridated.  Therefore, many of our patients are in “partially fluoridated areas” and it is impossible to account for the amount of fluoride being intake through public water use.  That means that if we do have a child that comes in with cavities and they are in a partially fluoridated area it is very difficult for us to prescribe personal systemic fluorides to be I ingested because of the potential for fluorosis, which are white spots that would form on the teeth due to over application of fluoride.  Therefore, it puts the child at risk for additional cavities which is difficult for us to control.  In fact, Kaiser, used to be the largest supplier of prescription fluoride (poly-vi-flor and tri-vi-flor) when I first started practice here and they no longer prescribe it at all because of this issue.  Therefore, in our area I cannot reasonably suggest that fluoridated water is a positive aspect for our community.  I would much rather go back to Dr. Guenette’s comment about giving people cavity medicine when they have cavities on an individual basis. Obviously, as a practitioner in this area for 40 years this is a hot button item for me which apparently has no resolution in our current political climate.  Therefore, the short answer to our patient was, in our area, no.  Hopefully these conflicts can be resolved sometime in the future and we can get on with a reasonable policy that can protect our children and our older adults from the ravages of decay with appropriate use of prescription level fluorides.