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.

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.