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.