Friday, September 23, 2005

Nothing is Happening!

Wow; nondescript week! Oddly, none of the following occurred:

- 90 minute extraction due to extreme decay and divergent roots
- patient consuming truly heroic quantities of narcotics and then have the nerve to ask for more
- uncontrollable screaming child ignoring the fact that we haven't hurt them a bit and bursting into tear for shear effect
- mom blames her cavities on the baby "sucking the calcium out of teeth" presumably in utero

I did have a woman lose her denture swimming (presumably in the ocean) and call in desperately wanting a new one. I fear she's going to ask to get it free, since we only put it in less than a year ago. I always appreciate it when you spill your coffee or drop your burger and the person at the counter says, "Aw...hey, here's another on the house." Tragically, I don't have that luxury.... The overhead is a bit higher. So, I'm going in today to see her. I'm off, but she's pretty upset, so hey. Maybe we can put in a flipper by next week....

I did have a young lady come in w/a lot of decay; we fixed most of it two years ago, but daggumit if she isn't STILL drinking 12 cokes a day... I'm sorry...correct myself; I said, "How many cokes do you drink a day?" "Coke? are you kidding? I don't drink that!" "Oh." "PEPSI is the only way to go." Duh. Anyway, I asked her if she ever did any meth. "What? Drugs?!? Heck no; I've got two kids!"

Ohhhhh. Well, speaking as someone who has lost a patient who OD'd on heroin while pregnant, forgive my not assuming the connection between motherhood and sobriety.

Similarly, I saw a teen girl a few months back. "Hey, Melissa; you didn't check this box on the health history. Are you taking any birth control pills?" "Huh? I'm just 14, silly!" Gosh, I wish is was silly. I wanted to pat her on the head, give her a (sugarfree) lollipop and a hug for being innocent and charmingly naive. At least 'til some 17,18-year-old jerk manages to take advantage of that. Seriously tho', the hormones interact w/ antibiotics (actually vice versa) so we need to know. And of course, a number of young women take them strictly for regulating their period.

One more. Me, jokingly, after extracting a retained baby tooth: "Ok, Jimmy - you a smoker?" "No way! I'm just 13!" Again, how many of my 20 year old smokers started at 12? Yeah.

"House" is back on the air. Both my assistant and I watch religiously and then compare notes, fantasizing about being that openly cynical in front of patients. Mmmmm. He and Dr. Cox on "Scrubs" are just the most lovely alter egos... of my id, at least. Or is that an alter id? Does such a thing exist? Paging Dr. Freud....

Tuesday, September 13, 2005

The only thing more fun than a dentist.... a GROUP of dentists!

What do we call a group of dentists? I mean, you've got a congregation of pigeons, a parliment of rooks, a murder of crows... So...maybe an extraction of dentists? An amalgam of dentists.... I actually like a gaggle of dentists. I mean, some people gag, and so.... hm.

I'll accept nominations!

In the meantime, I'll report on some activities of my local SOCIETY of dentists (Southeast New Hampshire!).

I'm happy to report that everything worked out fine with my event planning... The plate distribution of salmon vs. chicken proceded evenly, with no one sorely disappointed about missing out on their entree preference. Phew!

We also had a nice presentation by a hygienist from Tom's of Maine on their Community Involvement Program.

I'm a big fan, in that they are socially conscious organiation that makes natural-based products that are effective. There's a lot of "all natural" stuff out there that isn't worth the package it comes in. Tom's products, however, routinely earn the ADA's Seal of Approval.

(i just want you all to know I spent 20 min or more trying to import a .gif of the ADA Seal of approval onto this page. but i can't. Go pick up your toothpaste and look at that one. Thbbt.)

Anyway, along with giving hundreds of thousands of dollars back to the community, Tom's sponsors a program where they give dentists coupons to give their patients to buy Tom's products. The customer saves fifty cents and another fifty cents is taken out of the profit and given to various non-profit dental causes, assisting in access for those who can't afford it. Neat-O.

Secondly, we learned of many dentists in the Gulf Coast area who have lost their practices, or at least their patients, who have been dispersed across the region. 400 dental students in the area are going to have to be assimilated into programs elsewhere in the country. This strikes me as being a lot tougher than fitting a couple extra kids into each 4th grade class, since each student needs space to treat patients, etc etc. So, the ADA is contributing $10,000 off the bat, the NHDS is giving $5000, and a few component societies in New Hampshire alone have pledged up to $5000. As the local treasurer, we should be able to kick in a few thousand to the cause.

I can only imagine the total lack of options for people displaced by the storm - They have water but are struggling to just get blood pressure and diabetes meds; good luck if you have a toothache! So hopefully this will help.

In the meantime, I encourage everyone to buy Tom's products. Oh, and in case you care, I DO recommend Trident gum for my patients who chew gum. :)

Thursday, September 08, 2005

Kids are...Fun.

So, today I got to yell at a 7 year old. I am a mean, evil dentist. I am like Dr. Mengele, DDS. oh yes.

Nice little girl; we'd done 2 fillings and three crowns on her; just a couple weeks ago, she was reasonably tolerant when we did back-to-back pulpotomy/crowns on teeth A and B. So no worries.

Anyway, we brought her back cuz one of her earlier fillings (mine, I fear) had gone's hard to do a two-surface filling on a first baby molar, cuz the durn thing is like 80% pulp anyway, so good luck not hitting it.... So I did. Shoulda done the pulpotomy on it the first time, but noooo....

So we bring her back, and I'm trying to subtly distract her whilst sneaking up w/ the injection, but she's too smart for that, having been there before. So, she starts whining and crying, "I want my mommy" etc etc ad nauseum. So I use my happy Dr/Mr Rogers voice and explain very very gently how we don't WANT to hurt her, but you see, if we don't get those nasty ol' tooth bugs OUT of the tooth, (which I might add, IS currently sporting a deligtfully pus-filled parulis!) why, you might get sick and have to go to the hospital! Your face would swell up and look REALLY silly and it would really hurt! You don't WANT to go to the hospital, I don't want you to go to the hospital, and you see, that's why Mommy brought you here, cuz SHE doesn't want you to go to the hospital.

"I don't want to be here!!!! waaahh!"

Why? "It's going to hurt!!!"

What's that in your ear, sweetie? "huh?" The your earlobe. Are your ears pierced? "Uh-huh." Did that hurt? "Just a little..." Well, there you go..... no, just open... "I want my mommy!!!"

At that point she jerks her head dangerously close to appoaching syringe, therein threatening myself, my assistant AND herself w/ acutal serious injury. At that point, you can send her home, or get tough. It's no different that Super Nanny or Dr. Phil. Stop, lower voice, speak a little louder and quite sternly. "Jenny. It is VERY important that you sit still, or someone could get really hurt. Now, I know that you don't act this way at home. I know you are a big girl, but right now, you are acting like a four-year-old. We have four-year-olds that don't even behave like this! This is OUR office and you need to follow our rules."

A much subdued "Jenny" then opens and barely notices the injection. Was that so bad? [sheepishly] "no...." after that, easy procedure. 10 minutes.

So. Nothing new there, I get one or two of those every week. However, THIS time, I'm later pulled aside by a nurse I work with who really felt that I was too loud, too mean, and inconsiderate to the terrified little girl. Why didn't I let Mom back with her? Sometimes that helps them calm down. I should recognize that a lot of people have different anxiety and pain thresholds etc etc. She said that she TELLS her patients when she's injecting so they know what to expect. Also, as a mom, she felt bad for the little girl.

I seriously have the deepest respect for this woman, and I admit that I don't know everything. I further concede that "you're acting like a four year old" may be a little inappropriate. However....

1. Mom is in the waiting room with two other girls, 5 and 2. She can't hold "Jenny's" hand and watch the other girls. Further, I don't want them seeing the sister upset. The odds are, if no one hears horror stories from older siblings, they're just fine no matter what I do.

2. Having Mom in the room, more often than not, induces the child to act out. They "perform," knowing full well if they yell enough, Mom will scoop them up and carry them away. Lovely, but it doesn't help anyone in the long run. Additionally, having a parent there sends the child a message: "I don't trust this doctor, so if they hurt you, I'll take you away." The kid is then more apprehensive. Mom doesnt' stand at the door the whole day at school. Why? Because she trusts Ms. Applebottom, and Jenny can trust her too. She should trust us as well.

3. Nurses have the luxury of being able to inject people and turn them loose. All done! see ya! -I- have to keep them "on my side" for 30 min or more. If it were just about a quick stick, hey, no worries.

4. She didn't hear the entire exchange. Obviously, I didn't start OUT yelling at the little girl! You start out with lovey-dovey, of course....

5. Lastly, I KNOW this patient. This girl LIKES me and had never given us problems. Sometimes you need to step up and be a little intimidating to let them know "Hey, this is my house. You are not going to play that game." Now, if it's a four year old or a brand new patient, sure, you have to play it by ear.

Regardless, I still feel TERRIBLE for raising my voice and scaring a little girl who may just have been having a bad day. And, admittedly, I'm 6'2 and for all I know Jenny doesn't have a father figure, or even she's had one who is nothing but abusive. I don't know. So I feel bad. My assistant said I handled it "perfectly as usual" so that was gratifying..... Can't help feeling bad...Especially because I really like and respect the Nurse.... She knows her stuff, so I'm torn about to what degree I should have used a different approach....


Friday, September 02, 2005

It's Darts Season!

Yes, it's that time again, when I actually dabble in a meaningful activity that may even pass as a hobby. Yes, along with fish 'n chips, pubs and representative democracy, darts is one of our best British imports. There is nothing I enjoy more than standing in the company of a group of darters, consuming ethanol whilst hurling sharp objects. Brilliant!

I play on The Cockney Rejects, based at the Coat of Arms Pub in Portsmouth. We are the Boston Red Sox of our league - Always good enough for 2nd place! Even last year, the Sox threw off their curse, but we remained 2nd in the standings and 2nd in the playoffs. On the positive side, we consumed a lot of beer.

This season, we hope to recover from the loss of longtime team captain, Eden Moe, who, for some crazy reason that had to do with marrying a beautiful British physician, emmigrated to the UK. Eden and his clutch bullseyes will be sorely missed. Also, I'll have no one to shoot me dirty looks when I follow unconventional strategies in my singles matches....

Native Brit Nigel Smith is stepping into the captaincy. Mr. Smith is a master of throwing darts while drawing puffs of his cigarette, which is a clever trick, when you think about how easy it would be to hurl the butt and stab a dart in one's mouth... On the rare occaisions that he misses his mark, one can hear Nigel's characteristic explosion: "WANK-er!"

In the past, the British-ness of the team was bolstered by Roger and Simon; Roger plays on as an alternate, and also runs the pub in his spare time. We have no Callums, Olivers or Liams, however.

Ironically, Andy English is a Yank. Andy and I used to hang out at the same Irish Pub in Columbus, Ohio (Byrne's) but didn't know each other until moving to New Hampshire in '02. Andy plans on missing several weeks of the season this fall, for some crazy reason that has to do with marrying a beautiful American architect, and..... hmmm.... anyone else see a trend here? Anyway, he'll be back; Best Wishes to Andy and Cathryn, however!

Hailing from Dover, Dennis Wiggin and Chuck Schlicter will have to travel to Portsmouth for every game this season. Someone should offer to help with gas... Dennis finished on the leaderboards after coming on strong last season, and we're happy to have Chuck back full time from his educational hiatus of last season.

Joining the Rejects this season, Sean Lyons brings his mad phat Irish dart skills to the team. He was smart enough to get married last year (beautiful/American/therapist, for those keeping track of non-darts stats here...) so he shouldn't miss many matches this season!

We opened with a win this week at the Coat; our opponents threw valiantly, despite being down two players. They thusly forfeited three matches. I thusly only played one of the three matches I was scheduled for. Disappointing, but I won by default. "De, Fault! the two sweetest words in the English language!" according to Homer Simpson. Most notable was the tour de force of a throw by Mr. Wiggin, who had a round of five corks. This means that he hit the "red-eye" twice and also a regular bullseye just for giggles. I've never actually seen that done in competition. I did it once while practicing, with no one around to see.... *sigh*. No sour grapes; congrats to the Big Fella! Roger subbed for Nigel this week, as the latter remains in England on "Holiday," I believe. Although simply out-matched in his singles, rookie Sean acquitted himself very well, contributing to his trio's win in 601 and teaming up with Chuck to win a hard-fought doubles Cricket match.

In other news, the Coat's Soft Taco Special is delightfully spicy, but could use some more shells to help mop up the plethora of tasty goodness served w/ the soft steak. Yum.

Back to dentistry later.....

Wednesday, August 31, 2005

How to Extract Teeth

This is in response to a comment yesterday from Dave L, a first year dental student at UMB in Baltimore. You can check out Dave's site from my sidebar. Dave asks: "we haven't gotten to oral surgery yet I was wondering what is it about extracting teeth that makes it so difficult. I haven't seen a tooth extraction yet, but evidently there's a lot more to know than 'take a pliers and pull'."

Non Dental Types and the Squeamish might want to take a pass here....

Hey, thanks for the comment, Dave. To answer your question: Extractions are not hard, per se. Certain TEETH are hard. Go open your dental anatomy text and compare, say, #3 to #24. The molars, especially uppers, have three roots. If your text is like mine, it should show molars with a variety of roots, from convergent to highly divergent. if there's just one root, no problem, 2 minute extraction. 2 roots is harder. 3 is harder still. NOW pretend that the tooth is super decayed, so there's a minimal of cornal structure to grab on to! THAT was my patient yesterday. And there were two of those.

No, you don't just pull. You "luxate." Think of pulling up a fencepost. "Yanking" won't get you anywhere; you have to wiggle wiggle wiggle. bone is more flexible and less dense than tooth. So you can expand the socket. Then the tooth is ready to come out. If your roots are particulary divergent, you section into 2-3 pieces to remove in parts. If you don't have the access, you have to lay a perio flap (which is the gingival equivalent to peeling a banana) and then drill away the bone holding the tooth in. This is called a surgical extraction. To quote Dr. Hank, "If you're gonna take away bone...take away bone!"

A lot of dentists don't do surgical extractions, or extractions at all. They realize this is unpredicatble. The amount of time spent doing a surgical extraction (especially if you're not super good at it!) would be more economically spent doing a few crowns. So maybe you don't even have the equipment. This is what oral surgeons are for. This is why OSs can get up to $350 per tooth, as well.

Hank and I work in Community Health clinics and our uninsured patients are not super popular with the oral surgeons. So we end up doing a lot of it. We also end up getting pretty good at it; even a bit cocky. Some patient comes in, "Oh, Dr. Smith said I had to see an oral surgeon for that." Five minutes later, you're casually tossing that #16 onto a tray, making a flip remark like, "Congrats; it's a boy!" The patient is stunned. "Why did Dr. Smith think I needed an oral surgeon?" The temptation is to say, "Well, my friend; Dr. Smith is a, conservative practitioner." But we all know sometimes the tooth that looks easy isn't. So be careful of that.

Oh, and Dave - Please call them "forceps" from now on! If you even whisper "pliers" up in the clinic, the 4th years will peg you as the guy to send off in search of an "amalgam shade guide" when you start assisting.... word to the wise - Good luck!

Tuesday, August 30, 2005

Some mornings it just isnt' worth...

...gnawing through the straps...
-Emo Phillips

Good Heavens - a pair of extractions today took me nearly 90 minutes, as much due to difficulty of teeth (14,15) as to the patient whining about how much vicodin she had coming to her afterwards....

The two root canals I had today BOTH branched into accessory canals and other anatomic weirdness... (Hank; when was the last time you got a 13 w/ two??) and that took me forever. Now we're trying to change our computer system so the records are more accurate and so forth.

That's all well and good, but I'm FAST on the "slow" system I've been using for the last 2.5 years....! Well, such is progress. I keep telling the powers that be that the "new" system is going to make some peoples' jobs easier (data entry and collection) and other peoples' jobs harder (the dental department) so as long as they're prepared for decreased efficiency (at least in the short run), I'm ok with it.

Gotta go eat; hey, thanks for all the comments you guys! It really picked me up after a tough day. Also, see my comment to those comments... :) laters.

Monday, August 29, 2005

The Highest Praise....

So I cemented a crown on today, which is a bit unique. Here in Non-Profit Dental World, crowns (bridges, implants, etc) are a bit of a luxury. If someone comes to us and has a boat load of "bombed out" teeth, we can't just go and do root canals and crowns and all that jazz that most of you who are middle aged or older are familiar with, dentally.

It's more cost-effective (and the best use of OUR resources) to fill and save teeth we can, extract teeth we can't and then fabricate a partial denture (usually with a metal frame) to restore function and esthetics to some degree.

Of course, taking a denture out of your mouth to clean at night isn't the best thing with which you can saddle someone. But I can do one for about $340 for folks on the sliding-fee scale. Compared to $2500 or so for a bridge that replaces just ONE tooth, that's a great deal.

However, if someone comes in who ISN'T missing teeth, and, for some reason, has ONE bombed out tooth... Well, you can't say, Oh, sorry, let's extract and put in a partial for one tooth; that's crazy. So we do some root canals and so forth there.

Anyway, I finally finished an upper molar (#3 for dr hank and the rest of you) and cemented it. Everything worked well. No adjustment (insert plug for Captek here!) needed. The young man who is the patient went out to his mom (who paid for it!) and I asked her, Hey, what do you think?

She said, "Well... huh... I'm not even sure what I'm looking at; it looks normal."

I said, "That's RIGHT!" It's not what it looks like; it's what it doesn't look like, which is FAKE. So that's gratifying.

Thanks to Don, Hank and anyone else who's reading - if you're out there, leave a note!

Sunday, August 28, 2005

Almost Famous

The Daily Flos

Last night, at an upscale restaurant in town, we sat next to a pair of sharply dressed, professional-looking women. After a few sips of wine, I glanced at one of them.

With a flash of recognition, she exclaimed, "I know you! You're that fabulous dentist! We heard you speak at J_____'s party."

The party in question was a fundraiser/auction to benefit the non-profit for which I work. I remember working hard to prepare my remarks to be insightful, persuasive and witty.

I don't recall being fabulous, but I'll take what I can get! "That's DR. Fabulous to you, dahling...."

Rejected Dentist Blog Names

John Wayne was born Marion Robert Morrison.

U2 started out as The Virgin Prunes, while REM was originally Buckets of P#$%.

If a certain father who shall remain un-named had had faster X gametes, I believe I would have been Elizabeth.

So in the spirit of whismy (and since it's the weekend) I now present "Rejected Dentist Blog Names."

The Secret Lives of Dentists (already a film as well as a

book by the appropriately named Jane Smiley)

Dentisty Bites

Dentisry Bytes

Chew on This

On the Cusp(id) of Fame

Tooth Wisdom (one of Rachel's favorites of my ideas...)

Brace Yourself!

Mental Floss

The Root of All Evil

Open Wide (disturbingly, but not surprisingly, this is already, film. I will not hyperlink to it, but if you are an "adult" who is into "film databases" there is a "dotcom" where you can....bleah. i feel so dirty already....)

and the other two finalists:

This is Not a Drill

and The Awful Tooth

So, hopefully it's readily apparent that my chosen title is a play on The Daily Kos, which is, however technically pronounced "ose" as in "close," not "oss" as in "floss." But it's too well-known a blog to not play with the name.

Adios, amigos.

This is only a test.

working on tags!

you, jane... chuckle.

Saturday, August 27, 2005

A day at work.....

This is from 8/22....

ok.  So, my First Day of blogging after work.

It's 6pm, and it was a pretty well-balanced day.

Just 2 fillings, but 4 exams (2 kids), an extraction (easy!) a root canal (not bad) a denture impression and 3 emergency exams.

Emergency exams are interesting, as people aren't sure what to expect.  They usually don't expect me, I've noticed.  :)   Anyway, the most annoying emergencies are folks who no-show appointments.  They make an appt., stand us up, and then, sometimes months later, they call back, "Ooh, I have a toothache, I need to be seen immediately!"

It's hard not to adopt an attitude of "Well well well.  Look who's come crawling back!"

or, "I told you so.  I SOOOO totally told you so.  You said, 'ooh, the antibiotic fixed the problem' and we said, 'um, no, you see...' [CLICK!] [boooooooop] and then you hung up.  Not so bright, eh?"

But it does rankle one, let me tell you.  Hey, general public:  If it's a nice day, and you're gonna blow your dentist least have the courtesy to call and cancel, 'k?

Today's moment of Zen is brought to us by 10 year old Cody:

"OK buddy," I say, "It looks pretty good in there."

"No needles?"

"Dude, you're obsessed with needles.  No, not today."


"Well, if you're disappointed, I suppose I could...."
"No! nonononono!"

"OK, well, we'll just bring you back down the road for a cleaning and some sealants."

"Down the Road?  I'm going down the road?"

" a manner of speaking, yes."

"Are you coming?"

pause.  "Tell you what - I'll meet you there, ok?"

I think he was being a smarta---, but hey, it's charming in 10 year olds.

That's all for today as it have to buy some salad materials on the way home and the cats need feeding.  la!

Ah, moving day!

OK, I tried starting this on yahoo 360, but no matter what I tried, I couldn't get crawled or add tags. So, a friend suggested blogspot.... Vini, Vidi, Blogi.

Here's the old place:
Embryonic Stem Blog

And here is my "first post" to let ya'll know why I'm here!

(think of it as leftovers, microwaved to perfection....)

Why a Dentist Blog?? - August 21, 2005

As far as I know, there aren't really any dentists blogging!

I googled it and there's this guy:

FullOsseousflap's Blog

He is a dentist (which is cool, IMO), but he is also quite the Republican (which is less cool, IMO). I mean, if I google "dentist blog" I don't want some guy going on about the California GOP and Ah-nold etc. He's entitled to his opinions, and if this was 2003, heaven knows I'd be whaling away on my "Dean for America" drum....
But he seems to not even be relating to politics as it affects dentistry, which is odd to me.

Just so you all know, just because most of us are in the higher tax brackets, we're [GASP!] not all Republicans. (And I, for one, am a wretched golfer.)

Mad props, however, to Dr. Cole for the "Fullosseousflap" nickname. Doesn't make sense to those outside the profession, but hey, the same goes for a good 90 seconds of "Finding Nemo." ["Ooh, he's using a Hedstrom file." "That's not a Hedstrom. That's a K-flex!" "Hedstrom!" "K-flex!"]

Then there's this guy, which falls into the not-uncommon category of "why dentists suck," which you find in the form of jokes and gibes all over pop culture:
[watch out; coarse language, kids!]

Electric Death

I guess he's more opposed to the product. I advocate tray bleaching, myself.

Also somewhat annoyingly:

But, at least he replied to my [lengthy!] counter-post and was obviously taking me in better humor than I took his jab, so props also to Mitch Denny. His blog is "tech-y" but at least he's not flogging the Governator.... :)

Lastly, there's this guy:

Daily news and comments on the situation in post Saddam Iraq by an Iraqi dentist

Well, God bless 'im.... Again, more political, but HIS blog is actually stuff you DON'T get from CNN and Fox News. Not much dentistry, however. He has bigger fish to fry.

So. I have kind of a unique perspective. I have a doctorate in a relatively esoteric profession. I am currently the Secretary/Treasurer of my local chapter of the state dental society. However, I'm also still under 30 and reasonably tuned into pop culture. I can quote Spongebob, Jon Stewart, Harry Potter, and the Killers. However, I can't name Britney's husband. I think it's Kevin or Jason, but.... Furthermore (ahem - I am ridiculously tangential - apologies!)...FURtheremore, i currently work for a non-profit clinic, rather than a typical private practice.

I see patients who, by and large, don't have insurance, or they have Medicaid. Some haven't been to a dentist in 10, 15, 20 years or more. Some have been domestically abused. Some are slackers while others work 50 or more hours a week in, say, the restaurant industry, w/o health insurance. There are artistic intellectuals and there are paranoid schizophrenics. (Note to self: make Venn Diagram of these groups....) The point is, it's a very unique situation.

Sometimes it's heartwarming, sometimes it's stressful, sometimes it's funny. I find that keeping a sense of humor helps retain my sanity and ability to keep up what I do. Think of Alan Alda in M*A*S*H. I'll be Hawkeye with a drill..... stay tuned!