Disneyoholic

Just in case you have ever wondered why we have all the Disney memorabilia around the office there is a reason.  In 1968 when I was an undergraduate at UC Irvine, I needed a part time job to supplement my scholarships, grants and student loans so I went to Disneyland to get a job.  I was hired in the food services department and as a casual seasonal employee (Christmas, Easter, grad nights and summer) and eventually a permanent part time employee through 1972, when I was married to my wife Karen, and it was between my freshman and sophomore years at UCLA dental school when I started working as a dishwasher and moved up to line cook after the first summer and eventually to lead chef for the Tahitian Terrace restaurant (between the Tiki Room and the Jungle Cruise ride now known as Aladdin’s Oasis).  When I was working weekends as a part time employee I worked at the Plaza Pavilion on Main Street and Club 33 the private club above Pirates of the Caribbean in New Orleans Square.  During the winter months I would go in on Friday after classes and work 10 hours and then work 12 to 14 hours on Saturday and Sunday to pick up as many hours as I could.  I learned to work very hard and to be efficient, but most importantly I learned the Disney concepts of “host” and “guest.”  The concept is to treat both parties with respect and gratitude.  If you want to see a contemporary representation of that, watch the Disney film, “Saving Mr. Banks” with Tom Hanks as Walt Disney. That time frame is the time that I worked for Disney and I believe that it accurately betrays the Disney concept of how the “hosts” respect the needs of the “guest” P.L. Travers, no matter how she harasses them.  Although I never did meet Walt Disney as he passed away in 1964, I count his brother Roy as one of my friends.  In fact we watched the Armstrong Moon landing together on a 12 inch black and white TV set at “Station 13” at the Terrace.  Needless to say it is difficult to “outgrow” these types of experiences and training.  Thus I have been a Disneyoholic since then, as can be easily proven with my over 40 Mickey Mouse watches.  But what does this have to do with dentistry and our office?  Well I have utilized these Disney concepts in my practice with all of my staff (hosts) and patients (guests) trying to do the best that I could do for every one every day.  In the end you will have to forgive me for all the Disney stuff that I have around the office, but that is me.

Old vs. New

I am often asked whether it is better as a patient to be treated by a young dentist who has been trained in all the latest technology and is up on the latest trends and innovations in dentistry, or is it better to be treated by a seasoned dentist who has had life experiences and has done thousands of procedures like the one that you need to have accomplished.  It is an interesting dilemma, and a question not easily answered without some prejudices.  I believe it depends on the procedure that you need to have accomplished.  For example, I was taught at UCLA dental school in the early 70s to do gold crowns and silver fillings only.  And in fact the tooth-colored restorations as they are currently accomplished today were not even available until 1978, several years after I graduated.  On the other hand,  Dr. Naten who graduated 2 ½ years ago was raised on composites and ceramics, the bulk of our practice today, and is thus very comfortable with doing those procedures even though he has not done as many of them as I have.  I believe that the best method to even out this educational divide was derived in California many years ago with our continuing education requirements of over 50 hours of education each renewal period.  That certainly helps, but it is each individual dentist’s investment in their practice and care of their patients that is the real motivation to go beyond the minimum requirements and get as many continuing education units as possible.  In my case, our last office trip was to the Greater New York Dental Society meeting with over 55,000 other dental professionals all trying to get the most up-to-date techniques and bring them back to our practices to help our patients.  Our staff is committed to that education process otherwise they would not be here, and I am very proud of all of them for their dedication to improving dentistry and the health of our huge family of patients.  I believe this is the real answer.  Is the dentist happy with his or her work and do they look forward to going to work every day to try to help people?  If the answer is yes, I believe that is the dentist you want to see.   Fortunately in our office we offer treatment from both young and old dentists (Did I really say that?) so you get the best of both worlds.  As for those young dentists out there, watch out for us old guys and gals.  We are not necessarily behind you on the technology bandwagon.  You may have to look forward to find us rather than behind.

The Affordable Care Act

Well it is that time of year again, no not Christmas, Hanukkah, Kwansaa, or New Years, it is open enrollment time for the Affordable Care Act, until February 15, 2015. There are many that oppose this law and many that support it, but since it has been upheld by our Supreme Court, it is the current law of the land.  But how was it passed despite years of controversy?  Well a huge proponent of passage was the AARP, which stands to benefit with billions in income, and the wholehearted support by the American Medical Association.  But who is the American Medical Association really?  Well the story goes back to when I was at UCLA Dental School in the early 70's.  At that time the AMA and the ADA had a participation rate of their doctors of approximately 70%.  Our dental society decided to undergo a huge transformation to increase its recruitment efforts.  We began aggressively sponsoring continuing education classes, having annual meetings,  and then at the National, State and local levels began insurance companies, like The Dentists Insurance Company (TDIC) in California to represent us for malpractice issues and the multiple needs for myriad of other insurance issues.  In addition to working closely with state boards and legislatures to pass laws and regulations that help dentists, staff and patients overall well being.  What did the AMA do in that same time frame?  Nothing.  It was apparently way too much trouble for those involved to increase participants and it has been doing nothing for recruitment efforts since the 70's.  Therefore, currently the ADA has a membership participation rate of approximately 85% of all dentists and its is even higher in the Sacramento District Dental Society.  The AMA participation rate is somewhere between 14 and 17% depending on the report you read.  Who are the AMA members?  I would almost guarantee it is not your primary care physician at Kaiser, he or she is as upset with the ACA as any of it's most ardent detractors.  The AMA is made up primarily of academics and administrators (like our congress person (Ami Bera) and other “bean counters.” I only hope that we can fix the problems of the ACA before they are unsolvable.  Interestingly enough,  I am starting on Medicare this year and therefore I will not be a participant for long.

Uplifting Moments

I had a very uplifting moment last Saturday while working at the office.  It reminded me of my initial blog, so I thought I would put down my thoughts in this blog.  In late 1989 I saw a new patient family in our office and their young son, we will call him Jason.  Jason came in with his parents for an initial examination.  Over the intervening 25 years we have been treating him with regular cleanings and hygiene visits and a few miscellaneous fillings.  He had a typical complication we see with many young patients.  Some hygiene issues leading to the cavities that he now has fillings on.  He came in last Saturday to get his teeth cleaned and to say goodbye.  He had just graduated from college and at 30 years old he has become an EMT and is moving to Half Moon Bay with his young family to begin work there for the fire department.  He has always enjoyed the water and we spent many dental visits discussing his love for water sports.  Now he is very excited because the fire department in Half Moon Bay has water craft that the EMT’s use to help distressed patients out on the water as well as the more typical land emergencies.  I thanked him for his upcoming service to the community as a first responder and wished him well with his career and the life ahead that he is about to embark on.  Perhaps it is moments like this that bring me into work every day and make it so enjoyable.  Can there really be a better profession then one in which you get to help people every day over years and years and watch them grow and to mature into such important contributors to our society.  I think not, but perhaps that is why I am a dentist.

Tooth Replacement Options

One of the biggest dilemmas facing many of our patients is what to do about my missing teeth.  As a dentist, the answer is not always consistent or obvious.  There are four basic choices and none of the choices are right or wrong in every instance.  It depends on the size of the space, your age, where it is in your mouth and how important the tooth is to your overall dental health.  Moving between the choices from the least to the most expensive treatment, which translates to the easiest to the hardiest (remember the dentist is like the plumbers “time is money” thus the harder the job the more time it takes).  We will start with the first treatment and that is “oh well I lost my tooth.”  Obviously wisdom teeth or severely crowded areas of your mouth often fall into this category and no treatment is necessary.   Number 2 is a removable appliance of some nature.  That can be anything from a simple tooth attached to a temporary retainer, to a chrome removable partial denture with many teeth attached.  If there are large spaces, this is often the best choice as you pay by the appliance, and not by the tooth.  So if there are a lot of missing teeth on the appliance, it isn’t more expensive.  The downside to all removable appliances is function.  It is something in your mouth that may be a little foreign to you.  The 3^rd choice is fixed bridgework in which “caps” are placed on either side of the space and a “bridge” fills in the gap.  Unlike the removable appliances you pay by the tooth and it requires modification of your teeth for it to function.  Thus there are Novocain shots and all the other issues typically associated with dental procedures.  The last options are dental implants which are artificial roots that are placed in your jaw and a cap are attached to the implant.  This has the advantage of not relying on other teeth for support, but once again you pay by the tooth.  Although we restore several teeth each week this way, a surgeon has to place the implants.  As we all know specialists are not known for being inexpensive, therefore the cost can exceed $3500.00 per tooth by the time you are all done.  Thus this process often times is above our patient’s insurance coverage limits.  Once again, all of these are just choices and there is no consistently right or wrong answer to those choices as it is based on individual needs and desires.  But in general the more expensive the process, the more it looks and functions like your natural teeth.  That being said, implants are by far the most durable and functional therefore often times are lifetime restorations and therefore are best choice if you can afford them.