Keepin' It Real....

...wit' da bling!

Sooooo, it got to be NEARLY the end of December w/ no December post. Shame on me.

The lovely Michelle at Crackskull's wanted a gold tooth. I thought it was such a fun idea I did my own. Only set me back a couple large....



I should emphasize to the kids out there that this is NOT actually permanent... I stuck the little gold veneer on w/ a little wax. It hangs out there pretty well, but I have to take it off to eat. I can, however, drink with it! :)
Anyway, someone asked about this sort of thing on Yahoo Answers (shout out to B ez, yo!) and I figured that was a good excuse to publish.

Also, please notice my stylin' cowprint Pimp Hat. That's me. I can tell y'all too...It's hard out there for a pimp/dentist.

latahs peeps...

A Brush with History

So one of the fun things about living in New Hampshire is the quadrennial circus we host each primary election season. You never know when you'll be sitting around a coffeeshop and a Next President of the United States Wannabe swoops down upon your location with a bevy of aides, a phalanx of secret service and a ....er, whatever it is the Press congregates in - maybe an Estate of Media....

Needless to say, once this happens, you don't get coffee for a while.

Yesterday, our little town of Newmarket was graced by the presence of HRH Hillary Clinton, Esq. After speaking up the road for hours at UNH, she made a 30 minute meet 'n greet stop at "my" coffee shop, Crackskulls. Which, of course, was packed. I was stuffed between a jolly ex-stockbroker who was handing out ONE bracelets and a pair of women who were visiting from Florida and just happened to be in town. (Note to Floridians: Maybe the light down there is different, but just making your front crowns as white as possible isn't fooling anyone....)

So here's a snippet of said interaction in today's New York Daily News. Check it out.
(1/08 note: I don't think the above works...but check out the following!)

here's an embed of Hillary's day.... The Newmarket bit starts at 1:45 and you see/hear yours truly at 2:30.




I wasn't trying to be mean-spirited, but I suppose "gently joshing" is fair enough, and it does have a charmingly alliterative ring to it. Basically, towards the end of the meeting, Hillary was standing near the counter (notice my homie Michelle in the pic from NYD!) and some older guy was chatting about healthcare.

Hillary: "That's why we need to focus on evidence-based medicine (here I clapped, so she'd know I was all educated about that stuff) and more preventive things, such as monitoring blood pressure, diabetes, mental health and..." (here she pauses, lost for a moment in thought...)

Me: "Dentistry."

Hillary: "Sure! Dentistry! Oral diseases are very preventable, but 25% of children in this country have untreated cavities."

Me: "Insurance companies want to divorce the mouth from the rest of the body."

Hillary: "Which needs to be corrected, since the latest research is demonstrating the connection between gum disease and heart disease."

Let it not be said that Mrs. Clinton doesn't do her homework.

I mean, seriously, if she were talking to a pile of dentists, sure, or even doctors, but even my most educated patients are surprised when we discuss that research. (It's actually gotten a lot of press from Colgate, but despite using Brooke Shields in their ads, the topic isn't as sexy as, say, MRSA.)

Hillary: "Are you a dentist?"

Me: "Yep, I practice next door. Have a toothbrush!"

Let it be noted here that I told the Secret Service guy before hand that I'd be giving her a packaged toothbrush, which had been protruding out of my front shirt pocket in a way that may have made Sen. Clinton wonder if I was just kind of OCD.

Hillary: "Thanks!" (Holding up brush, smiling for cameras, and looking oddly like the Orbit gum lady:



Me: "Also, the brush is made from recycled yogurt cups and when you're done with it, you can mail it back to the company where they'll convert it to plastic "lumber" and make playground equipment."

Hillary: "That is remarkable."

Random guy behind me: "Have YOU seen a UFO?"

And we wonder why people hate us...

OK, this article was brought to my attention this weekend:
Story about insane pervo-goat dentist

Please read it all and kindly return for the requisite commentary.

OK, you probably had to get up and wash your hands or rinse w/ some Listerine to get the nasty taste out of your mouth. Bleaaggh!


If you like, do check out the commentary by Sarah from Cleveland.

She seems to be less affronted by the story than I would assume a normal female would be, in that I have a hard time being anything other than apalled. However, I DO have to agree w/ her big question: What on EARTH was wrong w/ the 31 year old woman in the story? Six incidents over two years? I mean, I can imagine her having a conversation w/ a friend, "oh, hey, when your dentist massages your chest, does he go under your clothes?" "Ummm...."

I'm reminded of the "Friends" episode where Joey discovers that the man he's trusted as his tailor since childhood has been engaging in some activities not related to letting out a hem. Oh, God Bless You Tube....here it is....



This has got to be a similar situation... I dunno. I do know that the WORST thing to say or even THINK in cases of sexual abuse is "Oh she really wanted it..." or "she said no but meant yes..." So I wouldn't say that, but I can't help but wonder if there was some kind of tacit approval of this activity? Yes, some people defer to authority no matter what, some people are ashamed and afraid to say anything, but ... TWENTY SEVEN women?? I can't wrap my brain around this.

Other questions: Where were the assistants before? Did they know nothing? Aren't they complicit in the abuse? How did this go on for FIVE years? Are people in California somehow denser? Is this going to be a black eye for Mormons, like Mitt Romney? (yes, he's LDS.... at least someone other than Catholic clergy are taking some heat...)

OK, that's all I can come up with for now.

Ooops! I came up w/ more. For NOW, you can still view said doctor's website.

I can't help but chuckle at the line, "Dr Anderson has a contagious sense of humor that he shares with his patients."
Should the snarky zinger I write be:

A - "Well, apparently they just didn't get the joke!"

B - "Let's hope that's the only contagious thing he's been sharing with them!"

or C - "Knock knock! Who's there? ..."

oh, I can't even go on.....

Before/After pictures of waiting room are forthcoming!

Vote for Recycline Toothbrushes!

Hello, loyal Blogites! As you may know, I'm a big fan of Recycline Preserve toothbrushes. Basically this company uses recycled yogurt containers to make various products, such as razor handles and tableware and the like.



You can check out their website here.

Not ONLY do they recycle the containers to make these fine products, but they THEN have an option for customers to mail the brushes et al. BACK to the company whereupon they will be melted down to create those plastic park benches and playground equipment, thusly:



Wow! Plastic lumber. Anyway, if that doesn't convince you, go watch the fine existential film "Stranger than Fiction," wherin the lead, played by a suddenly kind of serious Will Ferrell, starts hearing a voice narrating his life. Initially, this occurs whilst brushing his teeth. With a Recycline Preserve brush! ooh. Superstar!

ANYWAY, the company is now in the semi-finals for a seed grant kind of contest with Forbes, and they need your vote!

Help them out!!

They have great products and they're environmentally friends six ways from Sunday.

Fun with HGTV

Sooooo.... for anyone who doesn't know any creative, decorative, voyeuristic 26-34 year-old women (or, possibly Queer-Eye-style guys, both straight and not) - There is currently a phenomenon called "HGTV" where every show is a reality show that involves strangers attempting to drag home-owners into the 21st century with all manner of decorating tips, all of which are demonstrated with some sort of room/house/lifestyle make-over!

It started with Trading Spaces and has only degenerated from there...In fact, there was even a reality show where contestants vied for the honor of HOSTING the above kind of reality show... mirrors upon mirrors! I think that was called Design Star.
Then there's now Designed to Sell, Trading Up, Curb Appeal, House Hunters, Design on a Dime and (best title!) My House is Worth What?!?

So, these shows show up when certain young women congregate in front of televisions, in an act of specific vengeance upon the men in their lives who insist on watching Venture Brothers, Robot Chicken, Family Guy and Ultimate Fighting. ("Yes, I realize that I'm a scrawny, educated gentleman who tends to advocate non-violence. Yes, I see that those men are beating the snot out of each other.... But,...no...well, yes, but there's more TO it than that...it's like kinetic chess! Well, of course there's blood....")

Honestly, I stole "kinetic chess" from Sports Illustrated's write up on ultimate fighting and MMA.... Fair disclosure. No, it did not have the desired effect of justifying to said females that UFC is more than guys who don't realize that Steven Seagal movies aren't real.

So, we've got HGTV which has at least SIX shows involving people trying to sell their homes. One is called "Buy Me" and has this super creepy host who's like a combination of Rod Serling of the Twilight Zone and John Walsh of America's Most Wanted....

A discussion ensues here for those interested in delving into the psychology therein. I can't find a pic of Creepy Narrator.

Sooo, watching a recent episode of Buy Me. It always has people w/ these really irritating or depressing back-stories who are painfully desperate to sell their home. InVARiably they have ridiculous expectations. "yeah, we bought this 4 years ago for $230,000 and the house down the street sold two years ago for $400,000, so we're asking $550,000!!" Then they have 18 open houses and no one is even putting in an offer and then some beleagered real estate agent has to tell them, Er, maybe they should consider reducing the asking price... GASP! Heresy! wah wah wah.

the latest featured a couple in Vancouver trying to sell a high rise condo for (cue Dr. Evil voice) ONE point three MILLION dollars!! They'd purchased five years back for like $660,000 and are super pissy that they have to eventually drop to 990 or so....

here's a pic of the guy:



....and closer, for an even more SPECTACULAR view!


!
now SOME people (like aforementioned females [coughing, "HACKRACHELAHEM!"]) say, "Maybe Canadians don't CARE so much about their teeth." Um, no, you're thinking of the British. (Just kidding, Dr. Carling! Just kidding, Nigel!)

Well, if they don't care, they'll not mind me poking fun. My point is, this guy has, persumably, a couple million dollars in net worth and he can't be bothered to get matching veneers!

don't get me wrong - if he were homeless (and many of my patients are or have been...) I would NOT be making fun of him. I only do so because he's rich AND clueless. Hah! Take that, bourgeois!

Do note how 8 and 9 (the upper centrals) are FLAMINGLY WHITE whilst the adjacent teeth are painfully yellow. Tsk! you should bleach the others BEFORE getting the shining front crowns OR get front crowns that, I don't know.... MATCH. harumph. I think I can make some suggestions on how to spend $300,000.....

OK, I'll stop being mean-spirited now!

Sad Epilogue....

Oddly, this didn't totally surprise me, which is what sucks about being cynical when dealing with tough patients....

You all may remember the young woman who was hitting me up for drugs last spring?
If not, you can read about it here where I told the story.

Anyway, during my haircut recently, an employee phoned my cell to say, "Hey, wasn't her name....?" as the local paper carried a story about a young woman driving in the morning and colliding w/ a large vehicle. She died that day at a local hospital.

I attempted to upload a photo of the smashed truck/SUV or one of the entire top of the smaller car she drove which had to be removed before they could get to her, but Blogger wouldn't let me for some reason, and, of course, that's for the best.

I won't link you to the article, as it would identify the patient. Anyway, who knows if drugs were involved - I suppose that could come out in a future police report. I have to wonder, but after losing my own brother at 14, it always hurts when a young person is taken before their time, regardless of the causes.

Sorry I don't have more exciting dental news of late; I'll post more later, in August.

For Dr. Hank

This article was from Fox News online, and sent to me by alert reader Cathryn:

Idaho Canine Drives Owner's Car Into River
Friday , June 22, 2007
SAGLE, Idaho —

Bad dog.
Charlie the black lab is in trouble after driving his owner's car into the Pend Oreille River.

Owner Mark Ewing had just returned home from picking up a pizza Wednesday evening. As he walked to his home, Charlie jumped into the car through an open window, and apparently knocked the vehicle into gear.

"He somehow got the car into neutral," Ewing said. "My car just went boom, down an incline and into the drink."

Ewing could only watch as his Chevy Impala sank into the river. No dummy, Charlie jumped out of the window as the car went downhill.

"There's nothing weirder than looking at your car cruising down your driveway when you're not in it and seeing your dog jump out and then watching your car go splash," Ewing said.

Actually, things got a little weirder when the tow truck driver showed up.

Before the driver dove into the water to hook the car up to his truck, he asked Ewing to hold his dentures.

"My car's in the drink, I've got dentures in my hand and this guy Keith from Clyde's Towing goes swimming," Ewing noted.


--------

Let it not be said that Idahoans don't take care of their teeth, if not their cars...

In case you're wondering where Sagle, Idaho is, it's right down the road from Bonners Ferry, home to alert reader Dr Hank.

And to that grammar nazi who always corrects my spelling: no, there is no apostrophe in Bonners Ferry, even tho' there was a Bonner.

here's the map, click to enlarge:

Before 'n After

Hello - just a sampling of what overdosing on HDTV can do for you.... This was an "office" slash storage compound at my practice. While doing design stuff, Graphic Designer Rachel would squirrel away back there, and it would make her want to vomit, SOOO, everything had to go.... you can click on the images to make them bigger!

Just a shout out....

If I were a GOOD blogger, I'd be posting all the time, like ol' Rachel, but what can you do - the weather's nice and the lawn needs mowing constantly....

so, all I can do is shamelessly poach one of her photos, taken of me at Market Square Day last week. Mmmm, sausage....




Mad props to visitor COLLEEN - Hey, keep your chin up! Ultimately any less-than-exciting dentist might sell his/her practice to a younger, funner one! lol....

We should have some kind of blog get-together at Yankee this January for all my New England homies out there... :)

time for brunch....

Ummm....

So, there used to be this website called baddesignkills.com, which now just links you directly to the site of Von Glitschka (sic), who, according to Rachel, is repsonsible for some new and exciting "dots" on the packaging of Orbit gum. They're lovely, really, but try explaining that to the checkout lady!

Anyway, Von used to have this site, and then people submitted true stories of how people died in an actual airport fire in Germany due to poorly made fire exit maps. It turns out that looking at these maps LATER, people studying the tragedy had no idea what the maps said, so how could anyone expect people in the midst of a fire emergency to figure them out?

Another story relates how two newborn preemies at a hospital died after getting adult doses of blood thinner - turns out the doses are kept near each other and similarly packaged. So here's two cases of bad design literally killing.

The following, while vaguely prurient, probably won't kill anyone. But it sure doesn't help the profession, or that business:



Thanks to Crackskull's buddy Alicia for sending me said graphic. You rule.

Now I exist!

Well, it only took me 11 months, but I have finally hung my (literal) shingle:



There is some concern of asymetry amongst the graphic design community. More significantly, on the other side (where the sign is ostensibly the same looking north as it is looking south on Main Street), they neglected to add the "80" street address, so that's irritating. Allegedly the sign guys will come back to slap that up next week or something.

Here's the logo that appears on the door, and will hopefully find it's way onto business cards!



Did anyone else watch American Idol last night - the finals??
Anyway, there was a nice bit w/ the final six women backing up Gladys Knight on a nice rendition of "Midnight Train to Georgia." On some of the louder notes, I couldn't help but notice that Ms Knight is missing an upper left molar:



Still unsure of what I'm seeing? Look closer!



Gasp! I'm saddened to think that perhaps she was so exploited back in the day that she doesn't have enough money to restore a tooth that people can see when she performs! :(

That's all for today; More thoughts on Gladys (and jockey Calvin Boreil's edentulousness) later....

Here I am!

So, due to popular demand (well, really just a few of the dental students out there wondering, "Are your sideburns real?") I'm trying to include a few photos.

I'm also apparently trying to look smart:



And here's Linford:


....and Kirby:


And, perhaps, not so smart.....


The kitties like the warmth provided by the radiation of the laptop, methinks.

We now return you to your regularly scheduled blogcasting.... :)

Franz Ferdinand! Teeth! Darts!

Hey kids! Check this video out! Cool band and plenty of teeth and brushing action. ANNND as an added bonus, there's the 'darts' reference. Whoot!

Who got into my fantasies?



OK, admittedly, there could be MORE darts...And less British teeth (gosh, the drummer has teeth that could be described as less than "super fantastic!")..... but it gets credit for the choppers being anatomically correct, even if Alex Kapranos' brushing technique leaves a bit to be desired.

Anyway, to update those who care (I imagine that's two of you readers) the Cockney Rejects narrowly seized first place in the A-level Blue Division of the Seacoast Dart league, by edging out BC's Clam Doctors (don't ask) 7-4. A 6-5 win would have resulted in a tie, with first going to BC's due to them having won 2 of 3 matches this season. Thus the extra win was huge. As the 1 team, we had home pub advantage for the first round of the playoffs, wherein we handily dispatched the #4 Red Eyes team by a score of 8-3. In the latter contest, I won all three matches I played in, which is great, since the week before I didn't contribute any points. I should have been wearing my favorite self-deprecating t-shirt.

Alas.

Also, since I'm trying to get more photos, check out my new office:



Just kidding - that's in Puerto Vallarta, Mexico. Mmmm. Mexico. Felicidades Cinco de Mayo, Amigos!

And mad props to my Graphic Design Consultancy Team (ie, Rachel) for helping me to make this more visual....
check out her blog here.

I have a bunch to write about the Kentucky Derby, but more later....

Fair Game!

Greetings, and welcome to the Newmarket High School Career Fair Edition of the Daily Flos!

Check out the ink!

Newmarket High Schoolers Ben Chase, left, and Jordan Cartlidge watch as Dr. Nate Swanson demonstrates the process of performing teeth sealants during a Career Fair held on Thursday. Dr. Swanson owns Newmarket Dental. (Aaron Leclerc/Staff photographer)

"Lost" Revenue for taking the morning off: $2000
Cost of "Science Fair" style supplies and images: $142
Look of astoundment/worshipful awe on hard-to-impress 15 year-old males: Priceless

One thing I learned about high school students - They love love LOVE free exam gloves and surgical earloop face masks. One guy asked me, "Can I have a mask?" "Um...sure. Don't rob anything or try to do home surgery, 'k?" "Sweet!!"
Next thing I knew, three other kids wanted masks. And gloves. Then 10 more kids... The paper wrote, "Students swarmed around his booth, as much for the free gloves and face masks, as to learn procedures for doing teeth sealants and what kind of person it takes to make a dentist."

Swarmed I was! Good heavens, you would think I was giving away grillz or ringtones.... mercy. Next thing you know, I was out of masks and was having to ask kids to limit themselves to just the one glove a piece... The gym, now full of giddy, suddenly infection control conscious adolescents, resembled the Singapore airport during a bird flu outbreak.

I was kinda worried a vice principal would approach my table, look at me sternly and say, "Son...you need to stop causing disorder. If you continue with this behavior, you WILL be issued detention." Ulp!

Some insightful questions I was asked:

"Does your job involve technology?"
(Technically, yes...)
"Do you LIKE your job?"
(No, but I get all the masks and gloves I could ever want.)
"What's the highest level of Math you need?"
(Um...well, I have to count up to 32...)

One of my patients approached the table, grinning, with other boys in tow and said, "Hey. Um...can you do the voice?"

huh?

"you know...the RADIO voice..."

Oh. Soooo, dialing down my register, and speaking slowly, in a basso legato sort of cross between Barry White and Fritz the Night Owl, I intoned, "Good afternoon...it's 10:33, and you're listening to 94.1, WNHS, Home of the Mule, where the licks are hot and the tunes are cool... You just heard Pavement, Tori Amos and the latest from the Killers, and coming up, the new track by Cold War Kids. Right now, it's 42 degrees and partly cloudy. Time to stay in and turn up the rrrraaaadioooooo...."
(It's important to say this last word exactly as it's enunciated in Wall of Voodoo's "Mexican Radio" tune to really grasp the technique here...)

So that was a mistake, as I had to repeat the performance two more times, once for a group of awestruck girls and another for a couple of adults who may have been teachers' aides.... I consoled myself with the fact that if Mrs Caruso ever pursues the veneers she could sorely use, there is no question where she will go for the work. The other fact o' consolation took the form of 14 year old Nate rising up in the back of my subconscious, glaring at me and growling reproachfully, "OH, sure...nice...real NICE...and where were YOU in 1991, hmmm??? Don't recall gaggles o' females with sparkly eye shadow clustering about THEN, no sir..."

Dude, chill out, Half My Age Me! It's probably just the stylin' blue lab jacket we now wear.... if there's one thing that's a babe magnet, it's dentist couture, I tell you what....

In other news, my trusty hygienist, Jen, was a good enough sport to accompany me on this little venture. Upon seeing a boy in a "Seacoast United" soccer fleece, and knowing that she coaches one of those teams, I said, "Hey! Look at his fleece...is he one of yours?" "Nope," she replied, "I do Under-12 girls."

Now, it might just be the whole juvenile pheromone cloud that clearly surrounded us, but I had to stifle a chortle.
Jen glanced sidelong at me and said, "What?" "Oh, i dunno...I could repeat what you said, but I'm pretty sure I'd be dragged outta here in cuffs and would have to spend the rest of my career working with a shingle reading "Nate Swanson, DDS - practice limited to other registered sex offenders"

High schools can have that effect on you.

Here's the full article, and Hey, Mad Props to my pal Gretyl for working me into the story!

Go Bucks.... and odd websearches...

So, I would be remiss to not point out that "my" Ohio State Buckeyes have a shot at the national championship tomorrow, having neatly dispatched Memphis and Georgetown followig nail-biting wins over Xavier and Tennessee.

I'm kind of torn, however. My pal Sean is in a large pool, wherein he's been spot on the last couple rounds. If Florida wins, he'll take home a cool grand - $1000. So I'm thinking, Look, I'd LOVE for my team to win it's first title in nearly 50 years, but how can I root against my friends getting a new stove? I mean, the oven door doesn't even close all the way.... sigh.

So my favorite seach engine is Metacrawler, sinc e it kind of picks through all the other search engines to present a range of options when you're hunting for info. They have a fun feature called "Metaspy - ever wonder what the rest of the world is searching for?" Well, be careful what you wish for... I've been watching the searches just scroll by in the adjacent window and it's fascinating but a bit weird...consider the following:


free mature sex (I hate when you pay AND it's not ripe...)
breath hold underwater
black mistress trampling (ooh, who got into MY fantasies?)
trailer axle kits (spelling intact)
arthritis bra (followed by a search for arthritis braCLET)
married dating wyoming (Oooh, wait 'til South Dakota finds out!)
koverartist
nude singers slim (Somewhere Ruben Stoddard is VERY disappointed)
free medical textbooks
preteen boys (presumably there's a romantic 12 year old girl behind this one)
autoinsurance clean car carpet (Pulp Fiction, anyone?)
im still standing (congrats)

My favorite is whoever it is who seems to be searching every five minutes for "carpal tunnel remedies".... it just keeps showing up in various permutations, and I want to find them and say, "Hey, here's a tip... get the heck off the computer!!" That's like having AA meetings in a bar. sheesh. I was also amused by someone searching for "myspace." Hmmmm.. where to look, where to look....

Adios Amigos. Go Bucks. Go Sean....

Narc Hounds

Sorry about no recent posts - I've been busy trying to find a new assistant and the like, as well as covering the full schedule for my associate, who was in England for a couple weeks.

So a couple days back I'm in the office on a Saturday, doing some paperwork and seeing a patient for an emergency. My cell rings and it's a young woman...we'll call her Jessica Thompson. Jessica says she hasnt' been in in a while but she's a patient of record and she has a toothache...what can we do? I told her to just come on over and we'll take a look.

When she arrives I take a few xrays and discover that she has a blown out wisdom tooth on upper right...the lower right one is a bit dodgy too, and she has tons of big fillings, so who knows what's going on with those... I told her that she has an infection in the upper wisdom tooth and needs it extracted. She's concerned about money, since she's Medicaid. I told her we'd take that and could extract those teeth. "I'm very anxious, and need to be put to sleep."

(I love it when patients ask to be "put to sleep," meaning sedated. I kinda wanna say, "Well, have you talked to your family vet? I"m told they offer that service...")

OK, well, I"ll refer you to an oral surgeon who can do IV sedation. Here's a script for some antibiotics - how are you getting by w/ pain meds?

"Well, i'm taking a ton of ibuprofen and it's not helping much."

OK, we'll get you some vicod...

"Oh no...vicodin doesn't work for me, and I'm allergic to codeine."

hmm... what does work?

"Percocet. I have a high tolerance for pain meds"

Ahhah. ok...why such a high tolerance?

"Well, I had two C-sections and also an ovarian cyst removed, so I took a lot of those and I need a lot to work now."

Well, ok... we'll write you some Percocet....

"Oh, and the regular kind doesn't work for me."

Regular?

"yeah, the 5 mg kind.... I need the 10 mg kind."
(percocet is oxycodone plus acetaminophen...the narcotic is usually five mgs, but also comes in 7.5 and 10mg varieties.... Baby Bear, Mommy Bear and Daddy Bear. She wants the big guns.)

hmmm. OK, but let me tell you this: You are getting a LOT of serious stuff here. We are not fooling around. As such, if you don't follow up with the oral surgeon I'm referring you to, you will be dead to us. (OK, that's a paraphrase... not quite so much Godfather, but you get the idea, Gentle Reader)

"Its cool. I'm not a druggie."

(Um, never said you were - just told you to keep your appointments or we can't help you...)

So! Let me go make sure I write this all up in your chart before I forget.... It's Jessica Thompson, right? Hmm...lots of other Thompsons here...mom, grandpa, cousins....ok. No Jessica.... Let me go check the inactive files.... lessee...Hunting for Thompson.....huh! not there. Hey, Jessica - your last name ever change, or did you marry into Thompson?

"No."

OK, well, when you come back, I'll need you to sign a few papers and fill out a med history, but I'll let you go now, since you have to pick up your toddler.

So. Now I'm confused...after she leaves, I fire up the computer (remember, this is the weekend and they aren't usually running) and get into Dentrix and run a first name search on "Jessica." I find one with the appropriate birthdate, and it's listed under "Jessica Limbaugh." Sure enough, when I pull that chart, the label is affixed over another, and I can make out it used to be "Jessica Thompson." Upon pulling the notes out, I see that the last entry for Jessica Thompson (nee' Limbaugh) is from October of '05. My associate wrote, "Called pt to tell her we are aware that she is acquiring meds from several Drs and Pharmacies and we will not give her any more."

Now what's stunning here is not that someone lied to get drugs - that happens to me a few times every month. What's amazing is that it was such a bald-faced lie when I asked if she ever had any other names. Also stunning is the lack of shame of your average Narc Hound, cuz after she took the 12 percs I gave her Saturday, she was back for seconds on Monday. Still in pain, yes, she was taking the antibiotic, yes, she was taking Ibuprofen as well, and now she was crying and holding a two-year-old on her lap. Righto.

I say: Jessica, I understand you're in a lot of pain, and I want to help you, but we need to trust each other. I found your chart (holding it up) under Jessica Limbaugh. Did you ever go by that name?

"Yes, (*sniff*) when I was married....I guess."

OK, but Saturday, when I asked you, "Have you ever had any other names at all?" you said No.

confusedly: "Well, you see, it's just that I wasn't hardly married for very long at all." (pathetic tear drops duly noted)

I see. Well, I think there's a fair amount of paperwork involved in this sort of transaction - you can't just change your name on the internet - did the whole experience of being married and then not married just kind of slip your mind when I asked you?

(now sobbing) "Well...you see, a few months ago, I was in a car accident, and I had this concussion....wah wah."

Oh! OK, you had a concussion and some resultant amnesia that causes you to selectively forget that you were ever married?!?!?

"Waaah!"

Jessica, you should probably think of bottling some of that up, cuz I know a few people who would love to be able to selectively forget they were ever married....

So, I wrote another couple scripts to change up the antibiotics and get her another (lower end) pain med and told her to go to the oral surgeon. I found out that she ended up rescheduling her Thursday appointment with them to Monday AND got them to give her more meds 'til Monday, which just shows you how nice a guy Dr. Q---- is, since I'd called him to tip him off about her, but he still felt she must have legitimate pain (after five days of penicillin and 3 days of flagyl on top of it?).

So then she no-showed her Monday appointment. Or cancelled? I called her (from a phone that wasn't mine, I might add) and asked what happened. She said that Dr. Q----'s office wouldn't do IV sedation for her cuz it wasn't covered by her Medicaid, so she scheduled with Dr. Z----'s office a couple towns over. I'll need to call and confirm this, and alert Dr Z---- to Jessica's "high tolerance" problem, but I'm kinda skeptical about Medicaid ever covering IV sedation for extractions anywhere.... Perhaps Dr Z---- just figures it's easier to write it off than have people cancel cuz they're scared. However, if I did IV sed, I dont' think I'd want to expose myself, liability-wise, to a group of people who I've known to leap at litigious opportunities.... Hmmm.

Now, you can ask, Gentle Reader, "Gosh, Doc...how come you're so dumb? You KNEW she was scamming, didn't you?"
Sure I did. And that makes me feel like those guys who get caught on "To Catch a Predator" who are like, "Is this a set-up?" "No." "Well, OK...." "Hi, I'm Chris Hanson from Dateline NBC..." "I KNEW it was a set-up! I knew it!!"
Um, sure you did, moron, and you still walked in?

Well, I like to give people the benefit of the doubt, and don't forget, she DID have a gaping hole in the wisdom tooth. A past history of drug seeking (even for "legitimate (?)" reasons doesn't negate current pain.

As our President once said, "There's an old saying in Tennessee — I know it's in Texas, probably in Tennessee — that says, fool me once, shame on — shame on you. Fool me — you can't get fooled again."

(Speaking of politics, the psuedonyms used for "Jessica" in this piece are random, and are in no way related to famed substance-users/abusers from either end of the political spectrum. Thank you.)

Wisdom - The Epilogue

So the aforementioned patient from my previous post calls me the next day. "My face is throbbing and on fire and it hurts and is swollen."

"Are you taking Ibuprofen like I told you?"

"Yes, three of them every 6 hours." (You could ramp that up, but not too shabby there...)

"Are you following all the directions we sent you home with?"

"Was I supposed to read that?" (Augh! I KNEW I shouldn't have removed that wisdom tooth! Look what happens!)

"Er, sure...Anyway, take an ice pack, or a bag of frozen veggies and hold it to your face - 20 minutes on, 20 minutes off. That should help."

"Vegetables?"

"Sure. I think frozen peas work best."

"Eughh! I hate peas!"

Hopefully the insidious peas were unable to osmose through the plastic and her cheek so as to cause any REAL damage....

cha!

It's unwise to be too sure of one's own wisdom.

.... this according to Ghandi.

That said, I humbly present this dialogue between myself and a 31-year-old female patient with a sore tooth.

Dr: Your upper right wisdom tooth is both broken and infected. The good news is - It should be pretty easy to remove.

Patient: Right now?

Dr: Probably take about five minutes, sure.

Pt: Hmm. But is it ok to remove?

Dr: Well, if you had a really huge infection then that might complicate things, but I think it'll be fine in your case.

Pt: No, but I mean...it's a wisdom tooth.

Dr: That is correct. And it's basically shot - there is no saving it, only a lot of discomfort if we don't remove it.

Pt: But what about the wisdom?

Dr: (Where? I don't see any...) "Errrr....I'm sorry?"

Pt: It's a wisdom tooth.

Dr. (back on solid footing) Yes!

Pt: So won't it affect...my...um....you know....

Dr: (please be kidding please be kidding please...) "...um.....I'm afraid I don't...."

Pt: My wisdom.

Dr: Like, your intelligence?

Pt: I guess.

Dr: (trying really hard to not be condescending) Um, "wisdom tooth" is sort of an expression - they don't show up 'til you're older and presumably wiser...Not actually tied to any wisdom, uh..... (am I REALLY having this conversation?)

Pt: Oh. Just checking. So, can you knock me out?

Dr: (You're conscious now? Really?) Um we can get you numb...you'll feel only pressure.

Pt: What if it goes to my brain?

Dr: What, the anesthetic?

Pt: Yeah. I don't want my brain numbed.

Dr: I can guarantee the anesthetic is the least of your concerns.....


I am so not making this up.

During the extraction, this lady just about squeezed off my poor assistant's hand and kept loudly exclaiming, "I can't breathe! I can't breathe! I'm dying, I swear!"

Signs of airway distress: Short rapid breaths, physically labored ventilation, sternal retraction, cyanosis.... Hollering "I can't breathe!" over and over: not actually a sign.....

Afterwards, offered her mild narcotic for post-operative pain - "Oh, gosh no... I can't take those! They make me CRAZY!"

Ah.
We wouldn't want that....

Yankee Doodle Dandy

Hello all! Just got back from the esteemed Yankee Dental Congress in Boston - Ooh, the things to learn.

Had classes on:
Generating a Standard Operating Procedures Manual
Paperless Records
Implant Overdentures
Update on Posterior Composites
Early Treatment of Class II Malocclusion
ANNND
a fun class on Forensic Odontolgy.

Oh, sure, CSI looks cool for a while, but after seeing enough airplane crash victims who are not much more than jawbone fragments AND seeing a fair number of infants in morgues, one wonders how fun that could be....

more office upgrades to follow....

Office Spacing out...

Yo homies! sup? It is ONE A.M. and I am taking a break from painting painting painting the side operatory...mostly trim now.

Can I just say this: Professionally, I strongly discourage eating Nerds and washing it down with Red Bull.

But....Damn! It's like a party in my mouth and everyone's invited!

gotta go; my eyeball's twitching, which is my sign that it's time to re-paint!

"Repaint, repaint, and thin no more..."

Not dead yet....

...so, you'll all be happy to know that I survived my as-yet-undiagnosed mouth weirdness.

after 4-5 days, it stopped throbbing and shrunk up, tho' 1 week after it appeared there's still a small bump.

In other news I treated a rather horrendous trauma case yesterday - 15 yo kid comes in w/ his mom off the street (that is to say, not patients) and he'd fallen on some icy and took it right in upper front tooth (#9 for you dental types).
My receptionist referred to him as coming in with "tooth in hand" tho' actually it was hanging out in a large plastic Dunkin' Donuts cup w/ some milk in it. "Can you put it back in?" mom asks.... well, sure.... but will it stay?

The problem with the human head is that it sure does like to bleed a lot. I was recounting this incident to some architect friends and Mr. English excused himself to "go out for a bit of air." Apparently not everyone is fascinated by situations involving terms like "laceration" and "hemorrage." "Avulsion" is another fun one...

Anyhoo, shot him up w/ a carp of Septocaine even tho' it didn't really hurt that much to touch that area. Noted aforementioned laceration from cervical gingiva all the way up the depth of the vestibule to the subnasal area. The maxillary bone comprising the facial aspect of the #9 socket was fractured medially and apically and did NOT want to be reapproximated w/ the adjoining bone, which I found irritating.

So, rinsed off the root (don't scrub!) popped it back in and repacked w/ a whole sleeve of gauze and cotton rolls. I will say this. The blood doesn't bother me, but there's something deeply disturbing about an otherwise intact tooth having bits of asphalt still embedded in the enamel....

Rang up an oral surgeon for a consult and finally got a hold of the fourth one I tried.... (Hey guys! What's up with the extreme bankers' hours on a Wednesday afternoon?? You know who you are! JK....luvya all...) He suggested a number of steps w/ bonding some wire and suturing the tissue etc etc. I said, "yeah...boy, this always happens when you're half-way through a crown prep (#4). Dr. R---- was kind enough to offer to take the case and I was happy to refer.

Disappointing not to be "the hero" in that situation, but even after farming him out, my poor crown prep lady ended up being in the other chair for nearly 3 hours! yow. She was sympathetic and understanding, but still a tough situation.

The young man's mom came back this morning to say that things went well, he feels ok and the oral surgeon feels the prognosis isn't too bad to save the tooth. Hooray. Be sure to nail down the inevitable root canal before he's off insurance tho', right.... ? one step at a time...