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.

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.