The Daily Flos

Forget whitening...let's green our smiles!

2010-08-15T13:33:00.002-04:00

I've been trying to be environmentally respectful for a while now, but last January, inspired by a class at Yankee Dental Congress, I joined the Eco Dental Association (EDA) which can be interwebbed at http://www.ecodentistry.org/

Since then, I've worked to try to bring my practice onto a level where I can not only feel I'm doing some good for environmental sustainability, but as a business strategy I can stake out a niche as "the green dentist," a label I've perhaps even shied away from since joining the Seacoast Green Alliance (http://www.greenalliance.biz/)

So I'm finally putting together a brochure which will highlight some of my green initiatives, in the hopes of first advertising to existing and new patients what we're all about when we SAY "green dentistry" and secondly, challenging people to possibly suggest new things we could do which perhaps we've not even thought of!

Here's what I've got so far for the brochure:

Green Initiatives

Dentists often say, "You only have to care for the teeth you want to keep!" By 12 years old, the baby teeth are usually all gone, and we have to work to maintain these valuable little white appendages. Similarly, we only have one planet, so anything we can do to preserve the environment is a step in the right direction. While it's impossible to eliminate all waste, here's some things Dr Swanson and his team do to shrink our "footprint" on the Earth:

Digital X-rays - Eliminates plastic, lead and hazardous developing chemicals of traditional x-rays.

Electronic Patient Records - Reduce paper use, increase efficiency of communication with other providers.

Biodegradable seat covers and cups - Reduce CO2 production and break down in landfills.

Preserve brand toothbrushes - made from recycled Stoneyfield yogurt cups and recyclable as plastic "lumber" for benches, playground equipment, etc

Instruments and equipment - Use of reusables which are safe to sterilize in our autoclaves instead of disposables.

Email and text message appointment reminders; electronic claims, bills, band statements - reduce paper

Use of local dental laboratories - reduce packaging and fuel needs as well as supporting or New Hampshire neighbors.

Nearby bus stop - allows patients to use public transportation

Amalgam separator - prevents mercury from escaping into the environment

Office Recycling - reduction of landfill "trash" by separating out plastics, paper, aluminum and glass

----------------

So any suggestions? :)

Severely Misplaced Hate

2009-09-23T17:57:00.003-04:00

So today someone (presumably reading some of my posts on Yahoo Answers?) commented on a post from Jan '08. They wrote:

"I was just reading what you said elsewhere on the internet in response to a person who asked why dentists cost so much. I don't buy your response. If I were suddenly made dictator of the US, the very first thing I would do, no exaggeration, is make dentists slaves of the state. They would then be forced to give quality dental care to anyone who needed it, for free...because I know that dentists do not need to charge what they do. They're/you're not missing any meals- but GUESS WHAT? Plenty of other people are so that they can get the care they should be entitled to as human beings in order to live a healthy, pain-free life. I understand perfectly your position- you know that people will pay ANYTHING to alleviate pain in their mouths- and you capitalize on that. Yes, I am bitter. I too owe over 100,000 in student loans- so that I could get degrees that would allow me to teach children...however, I certainly don't feel entitled to blackmail my students' parents by threatening to withhold their educations in lieu of receipt of extortionate amounts of cash. Bottom line: I do not like dentists and I hope the US 'socializes' medicine and you lose your lucrative little lifestyles and have to live like the rest of us. Medical doctors probably don't even live as well as you. You should be ashamed."

Well. At least you're not bitter....oh wait, you admitted you were.

I'm not sure where to begin. First of all, you know who should be ashamed? Someone commenting on this under "Anonymous." Yes, way to engage in a meaningful dialogue - go online and sling arrows around from behind a screen. If they read my answer somewhere else, it means they have a Yahoo account and they very well could have contacted me through there and talked about this a little more reasonably, as opposed to flinging vitriol in a blog (commenting, I might add on a post that simply welcomes my infant nephew into the world and has nothing to DO with dentistry!)

Mr/s. Anonymous: If you happen to check in here, feel free to do so and I'm happy to look at your concerns. Seriously. I believe you have some valid points but I believe you're misinformed on a few points.

Let's review. If you were made dictator of the US... stop there. You're a teacher? really? obviously not of Civics, Government or History, or you'd know we live in a democracy. But it's a rhetorical device. You want to make your point, fine. You'd like to enslave dentists and have them be "forced to give quality dental care to anyone who needed it, for free." Again, find a civics teacher, but this is called socialism. I sure as heck voted for Barack Obama, and I voted for (Dr.) Howard Dean and I sit here watching right wingers call these guys socialists, but I'm pretty sure there aren't too many Americans who REALLY want to live in a pure commune. Most of us believe that those who work harder (and to some degree those that are more talented or smarter) deserve more rewards. Are the current rewards proportional to how hard everyone works? Absolutely not, but I hardly think dentists (while sometimes "bad") are the worst offenders... we don't get, say, $10 million bonuses for getting lucky while taking risks w/ other people's investments. We don't make $20 million a year for being the star of CSI or for shoving a ball through a hoop. The bottom line here, however, is that you CAN'T "enslave" anyone and then expect "quality care." I think they kinda tried it in USSR and you had a lot of unmotivated doctors. You can build a pyramid or harvest cotton but you can't get people to perform at high levels involving critical thinking, artistry and compassion. (yeah, a lot of us have compassion, say what you will.)

"I know that dentists do not need to charge what they do."
Really? how many dentists do you know? Have you BEEN a dentist? Gone to dental school? Managed a dental office? Do some docs overcharge, upsell and price gouge? Yes. And the same is true of mechanics, athletes, ballerinas, contractors, engineers, architects, florists, whatever. Do you honestly expect everyone to charge no more than they need to to "get by?" Even if this were a realistic expectation, where's the motivation to be GOOD at anything? You'd have a society of mediocrity, on every level. And how on earth do you decide what constitutes a "reasonable level" of income? Who gets subjected to these dictates you'd propose? Everyone who makes more money than you?

"They're/you're not missing any meals- but GUESS WHAT? Plenty of other people are so that they can get the care they should be entitled to as human beings in order to live a healthy, pain-free life."
Ah, so you can make only enough to put food on your table and no more as long as ANYone goes to bed hungry. Interesting. The thing is, we can SOLVE hunger in this country, if not the world, by applying technology, ingenuity and compassion. Yeah, we need to trim some profits here and there, but we don't have to clip everyone back to subsistence levels. Your level of arrogance is astounding... seriously, you're telling ME that people are hungry, suffering and in pain?

I saw those people and cared for them every day when I was in dental school. I see them on a pretty regular basis come into my practice, where I'll knock off the charges for exams and xrays so that they pay only the cost of an emergency extraction. (Oh, that should be free too? I'm sorry; i'll just tell the SEVEN people for whom my small business provides good, secure jobs that I can't pay them anymore and we'll see how many people I can help all by myself...) I saw those hurting, hopeless people every DAY when I worked for three years full time at a non-profit clinic, at which I still spend two days a month because I believe in helping those in that situation. I see these people when I spend time (and money out of my own pocket) working with service projects through my church. I see the people only somewhat better off than the homeless or jobless who are struggling to maintain their own small businesses through my volunteer service on the board of my towns Business Association.

If you, Mr/s Anonyomous had bothered READING any of my blog posts you maybe would know these things about me, but hey, it's a hell of a lot easier to just hate all dentists, isn't it? I KNOW you didn't bother reading, because in your next comment from the 1/08 post you mention "your baby." It's not my baby, it's my brother's baby, but again, why bother reading when you have vindictive angry verbal epithets to spew?

"I understand perfectly your position- you know that people will pay ANYTHING to alleviate pain in their mouths- and you capitalize on that."
I think we've established already that you know NOTHING about me. That said, I'm interested that you view the whole dental profession as simply waiting around to provide extortive care to those in pain. In case you haven't noticed, we've spent the last 100 years or so hollering and waving our arms for PREVENTION - we are actively engaged in TRYING TO RUN OURSELVES OUT OF BUSINESS, trying to get soda machines out of schools, get fluoride in local drinking water, encouraging an often complacent population to just put some freakin' floss in their mouths now and then!

Of course, if you're only going to the dentist when you're in pain, I would imagine that it WOULD seem that way, which leads me to believe you're so anti-dentite that you ONLY engage in emergency care... Guess what? it's more expensive that way. Oh, i know, you're going to say you don't have insurance and can't afford to come in. Yes, there ARE homeless, jobless people out there who really do need a safety net, but MOST people who make the "i don't have insurance" argument haven't even bothered CHECKING to see how much it would cost to come in for a routine visit. Cleaning, $70; exam, $50-80; x-rays, $50-80. Basically $130-$250, and that's in NEW ENGLAND where things are more expensive than Midwest, South, etc etc. OK, so maybe you go to a dentist that upsells you stuff you don't need. I'm not a fan of the free market economy in all it's forms but by golly, shop around 'til you find someone who'll provide BASIC services. WE ARE OUT HERE.

"I too owe over 100,000 in student loans- so that I could get degrees that would allow me to teach children..."
Well, as soon as Pope Benedict asks my opinion (and as soon as you tell me your name) I'll be sure to put you forward for beatification and sainthood, my friend. Do NOT even try to tell me that any profession is soo much more NOBLE and BENEFICENT than any other. They all have their angels and they all have their demons. For ever evil money-grubbing dentist there's a lazy complacent teacher who can't be fired due to union rules or their tenure who are just marking time 'til their retirement, not caring if kids actually LEARN. For every noble "Stand and Deliver" "Dead Poets Society" "Dangerous Minds" teacher out there, I can tell you there are dentists and doctors in the trenches actually trying to make the world a better place, often at significant financial expense. You aren't BETTER than me cuz you're poorer...if you think you are, go find Nietzche and read his opinions on "slave morality."

Oh, and if you took out that many loans, getting into a profession where the financial remuneration is proportionally less than mine, don't come crying to me. I SWEAR I vote for the people who are trying to change the system whenever possible - teachers should be as comfortable and respected as health care providers or any other profession. Seriously, you typed your bitchy missive to quite possibly the most LIBERAL dentist in the state of New Hampshire. I'm on YOUR side, you daft fool, I'm trying to help and maybe fix things "from the inside." I don't golf, I'm not millionaire and I drive an 8 year old Camry.

"however, I certainly don't feel entitled to blackmail my students' parents by threatening to withhold their educations in lieu of receipt of extortionate amounts of cash."
Oh, well, then clearly you don't work for an institute of higher education, where the cost of getting a bachelor's degree (never mind a doctorate) are outstripping the CPI or rate of inflation at a truly dizzying rate. Pretty much, that's what college IS right now, is blackmail to withhold a real and meaningful education from those who can't afford it. And I won't pretend that doesn't exist on the secondary level where people who live in a crappy school district have to either spend thousands on private schools or let their kids slog through a system with barely competent teachers (the typically least likely to get jobs in better districts) and inadequate supplies. Again, i'm ALL ABOUT changing the system with loan repayments or financial incentives to get hte best and brightest teachers in the schools that NEED them most; you're preaching to the choir, Rev Anon. I won't bother telling YOU that a good education is expensive!

"Bottom line: I do not like dentists..."
Like a good book report, it's always nice to restate your main thesis in conclusion. Thanks. I hadn't picked up on that tidbit.

"US 'socializes' medicine and you lose your lucrative little lifestyles and have to live like the rest of us. Medical doctors probably don't even live as well as you."
Go Populism! Us vs. Them! Down w/ the bourgeoisie! Cripes, I'm a LEFTY and I've never been so inclined to yell, "Go to Cuba, ya pinko!" I never thought I'd see the day. I've made the points above, but you have no idea how I live, you have no idea how much debt I have and you certainly have no fucking clue how much I already give back in time, care, ideas and Yes, money.

"You should be ashamed."

No, shame on you.
Shame on you for posting anonymously.
Shame on you for making wild and inaccurate generalisations about an entire profession.
Shame on you for making foolish and hurtful assumptions about a person you've never met.
Shame on you for not doing a little basic research to LEARN about me before posting your screed.
Shame on you even for your insipid and disingenuous faux-erudite attempts at an intellectual smack down.

As disgusted as I am by SO many in my profession who DO take advantage of the less fortunate, I'm almost more appalled by people like you who ALLOW the them to paint the left wing with gross, mischaracterized brushstrokes, and who use your irrational, shoot from the hip rantings to scare their right-wing followers (usually the POOR, ironically) into supporting their policies.

YOU should be ashamed.

Olympic Post Script

2008-11-20T00:17:00.003-05:00

So I've kinda been meaning to post these shots for months and have been distracted by the Election and Facebook...

Anyway, I was intrigued that apparently the fastest man in the world may be aided by NOT being weighed down by big heavy molars....

Note the lack of 3, 14 and who knows what else....

Anyway, I hope Mr Bolt made enough in endorsements and so forth to get some implants or something. Makes you think a bit about the whole differential in standard of living w/ US vs. poorer countries.... more later!

Can You Dig It?

2008-08-23T19:19:00.003-04:00

So, here I am, finding my mug in the local news publication yet again... Kind of embarassing, but for a very good cause:

"NEWMARKET — Backhoes and the color bright, construction orange are familiar sights downtown. They are also the part of a new T-shirt to help businesses during this year’s downtown reconstruction.

Local organizations looking for ways to encourage people to shop at downtown businesses during construction were the inspiration for the T-shirts, which were designed by Nathan and Rachel Swanson of Newmarket Dental. Nathan Swanson is on the Board of Directors of the Newmarket Business Association (NBA).

"We were looking for ways to promote the idea that during construction, Newmarket is still open for business. The economy is certainly struggling and given people are detouring (through town) it’s potentially harmful to a lot of the small businesses … the big take-home message is to encourage people to shop in Newmarket," Nathan Swanson said.

Proceeds from the T-shirts go to "We Dig Newmarket," a collaborative effort to help encourage people to do business downtown. The initiative offers Saturday music serenades from 11:30 a.m. to 2:30 p.m. The group has also installed signs along Spring Street pointing people to access points for local businesses, said NBA President Gerry O’Connell."

Read the full article here,
though I have to confess, the caption saying that I "helped design" said t-shirt is a bit generous, given that Rachel did 95% of the work...

Check out her new employer! Click on Vital Work then on Identity to see some cool logos. She's currently enterprising to re-brand a local bowling alley...

Tune in next time for some discussion of Olympic athletes and missing teeth...

If only John Lennon were still alive...

2008-07-01T10:30:00.004-04:00

This nice young man:

...is Maxwell Rome. He was recently arraigned in our local court for swinging a hammer at a fellow combatant during a fight in a liquor store parking lot, splitting his scalp.

Now seriously... if you actually KNEW someone named MAXWELL, wouldn't you be on the lookout for his HAMMER? C'mon...

the full story is here.

I'll admit Rachel gets full credit for A) noticing the article and B) making the connection. But she's a bigger blog slacker than me, so someone had to post it...

Package Deal

2008-06-25T21:00:00.002-04:00

So, I've long been fairly annoyed by the degrees of inefficiency inherent in our mass-producing, commerce-worshipping, environmentally insensitive culture. At a previous dental office, I had a sort of horrifying epiphany when I saw how much PAPER was thrown away by JUST that office. Plus how much was thrown away by the five identically sized offices in that building. Plus how much was thrown away by the identical three buildings (18 offices) in that office park. Suddenly, I felt as though I was in a film, the camera panning out, zooming ever upward to include my town, then New Hampshire, then New England, North America and the Earth. In each phase, the amount of paper increases exponentially.

Sobering.

You can well imagine my irritation upon ordering a small diamond disk (used for opening contacts between teeth) which came in this plastic case:

That, in turn, was shipped in the following box:

C'mon, dental supply companies! (I'm talkin' to YOU, ironically-named SmartPractice...) You could've shipped that in a small padded envelope!

Stay tuned...I'll keep you all posted on my plan to use corn-based plastic bags as chair covers...

De-Motivation...

2008-04-07T01:03:00.003-04:00

Oh, sometimes you just find something on the ol' inter-web that is just too fun for your own good.

Everybody remembers those cheesy motivational posters from the late 90s? "TEAMWORK" and there's a photo of a rowing crew and some pithy saying like, "The whole is greater than the sum of the parts." (or is is the sum of the squares of the sides of a right triangle? I can never remember...)

I had a faux one of these posters in my locker in dental school. It had a lovely shot of the Leaning Tower of Pisa:

Underneath it read: MEDIOCRITY - It takes a lot less work, and no one really notices the difference 'til it's too late.

Now, as anyone who knows me will tell you, I really try to be anti-mediocre...however, with all the assignments of dental school, my perfectionistic tendencies would have killed me in under two quarters. The poster reminded me to accept a little imperfection here and there, or I'd never finish anything.

Anyway, this site:
Motivator
allows you to make your own. Too much fun!

Here's my contribution, w/ credit to my loving cat-loaf, Kirby:

It's aLIIIIVE!!!!!!!!!

2008-03-15T02:15:00.003-04:00

So I can safely say that it's only appropriate that the post noting the birth of my nephew is followed by the post celebrating the birth of......[drum roll]

My Web Site!

yessir.

Be sure to browse about...enjoy the lovely layout...the delightful fonts...the ease of navigation (?)....

Anyway, do let me know your opinions, but mostly we're just hunting for compliments...

Mad props to Rachel and the wonderful people at Hatchling Studios.

Baby!

2008-01-26T21:27:00.000-05:00

Nothing to do w/ dentistry, but some cute photos of my brand new nephew, Henry Phineas Swanson.

Here he is sleeping:

Here he is with Rasput... er, Papa Steve:

And here's a charming knit ensemble!

I like the obvious hand motion, like, "Yo, peeps...H-Phin in da hizzie...ya'll feelin ' me?" Or whatever it is babies think.

"Babies," according to Rev. Grayson Atha, "Are proof that God thinks that Life is Good and wishes for it to continue." (I think someone else may have said that first, but I'm sure they didn't sound as auspicious as THIS minister during baptisms...

Fun Signs

2008-01-25T11:57:00.000-05:00

Hello, O Bloggites! Tragically, it has been another busy month. Apparently, everyone who was holding off on a crown until their insurance renewed likes to show up in January, PLUS the weather, and I had (in one week) the excitement of the College BCS Championship, New Hampshire Presidential Primary and my Birthday. This resulted in three straight days of disappointment, as the Ohio State Buckeyes, Barack Obama and The Last Vestiges of my Youth (respectively) all performed a bit below expectations.

Speaking of presidential candidates, please take the time to skip down two posts - I've added new VIDEO of the Hillary Encounter. (Hmm...that sounds like something new at the Museum of Natural History...)

For a truly whimsical look at the candidates, please check out this Best of Craigslist Entry.

Lastly, for your amusement... I have lately become mildly obsessed with CollegeHumor.com, ever since their rendition of "Street Fighter: The Later Years." Lots of funny videos and pictures, and I find it MUCH easier to browse than YouTube.
From the Dental Dept:

In the newspaper business we call this "tombstoning:"

Bad Molar? We'll chop it out! Hiiiyahhh!

And people DO sometimes pray.... (Rev. Wallick? You out there?)

Free Bible with Every Cleaning!

Mad props to the guy in the photo who is brilliantly emoting the simutaneous concepts of, "Hallelujah!" and "Owww...my tooth!" (Any guesses, however, on the source of the stains on his shirt?)

Keepin' It Real....

2007-12-27T23:24:00.001-05:00

...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

2007-11-02T12:11:00.000-04:00

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...

2007-10-15T22:02:00.000-04:00

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!

2007-08-21T23:19:00.000-04:00

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

2007-08-15T12:24:00.000-04:00

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....

2007-07-29T20:10:00.000-04:00

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

2007-06-25T11:01:00.000-04:00

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

2007-06-23T09:58:00.000-04:00

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....

2007-06-17T12:12:00.000-04:00

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....

2007-06-10T01:39:00.000-04:00

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!

2007-05-24T21:45:00.000-04:00

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!

2007-05-14T23:45:00.000-04:00

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!

2007-04-28T16:54:00.001-04:00

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!

2007-04-13T10:15:00.000-04:00

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...

2007-04-01T12:25:00.000-04:00

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

2007-03-23T18:25:00.000-04:00

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

2007-02-11T18:37:00.000-05:00

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.

2007-02-10T15:37:00.000-05:00

.... 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

2007-02-01T23:28:00.000-05:00

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...

2007-01-13T01:10:00.000-05:00

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....

2007-01-04T23:49:00.000-05:00

...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...

Palatal Lesion!

2006-12-30T20:17:00.000-05:00

Here's what I posted already to Yahoo Answers....
Hi! This is driving me nuts! OK, I usually get sick on vacation - immune sys. shuts down and I spend half of the time buried in a tissue box. This past week, no exception - started w/ sore throat xmas eve which has persisted 6 days. in b/t, have had rhinitis, sinus pain 'n congestion, cough. I've tx'd w/ lozenges, Vit C, fluids, boatloads of ibuprofen and a few tyl and/or tyl sinus here 'n there.

OK, so far, par for the course. Virus, cold, whatever (btw, i did have flu shot one mo ago...). YESTERDAY, I noted a slight swelling upper hard palate, ant. to vibrating line and 5mm medial to #s 2 &3. today, more swelling, lesion is maybe 3x5mm w/ a smaller 2x2 adjacent. tiss is slightly erythematous, dome-like, non-ulcerated, v tender to palp. no exudate.
my differential so far: salivary? lymphatic? drainage from sinus inf?? it is quite sore and thobs a lot. Any thoughts? (flew Ohio to Bos Fri AM and spent week driving 'roung OH/MI....?) Any thoughts?

Additional Details
8 hours ago
OK, i know it's not traumatic, as there's no ulceration. Secondly, I do have a very slight hx of H. labialis - the prodrome tingle and then lesion, tho' that's only occurred 2-3x in my life (mostly in school, i might add...). But again, there's one dome-ish lesion that MIGHT look herpetic, tho' the large one is nothing like....
They are still there going on 36 hrs but they are less painful than yesterday eve. also, i slept for like 14 hrs last night, so that was maybe helpful.
0 seconds ago
Yes, I considered the parulis/fistula possibility w/ the palatal root....but this is WAY up on the vault - almost adjacent to the midline and not on palatal of the alveolar process.... plus tooth is totally assymptomatic - no hot/cold or percussion sensitivity and no resp to attempting to move indiv. cusps. I have not had a chance to get to the office for a PA however....and I do probably have a good sized comp in there.

tagging....

2006-12-23T10:58:00.000-05:00

I'm going to take a stab at getting noticed by spiders. Let's see what happens:

(oh, and don't click on these; they'll just take you here. and you're already here. why leave?)

dentist blog

dentistry blog

nate swanson

nathan swanson

nate swanson, dds

and now we'll try these:

dentist blog

dentistry blog

nate swanson

nathan swanson

nate swanson

nathan swanson

dentist blog

dentistry blog

Karma....?

2006-12-17T16:21:00.000-05:00

OK, so last week I had the strangest experience I think I've ever had.

Not dentally related, but still...

It was unseasonably warm, so I was enjoying a coffee and reading a new book on a park bench before heading to work.

The sun was shining, a light breeze was blowing and the birds were singing. I felt a soft tap on my shoulder and realized that the birds were not just singing, but pooping on me as well. Nice.

(this is the point in the story where a number of listeners quickly point out "That's good luck!")

Funny you should mention that. So, I stood up and headed for a store where I could attempt to clean my jacket in the restroom. Not two steps away, on the ground in front of me and with no one else in sight, I noticed a crisp new FIVE DOLLAR BILL! Well, that's not a bad trade-off. Especially since the bird-doo easily cleaned off the soft leather jacket.

But that's not super weird..it's not as ironic as, say, winning the lottery, running out into the street to celebrate and getting hit by a truck. No, what was most bizarre was the book I was reading.

It's a collection of short stories entitled "Things Fall from the Sky."

I (bird) sh-t you not.

Put yer money where yo mouf iz!

2006-12-10T11:43:00.000-05:00

Well, another career milestone has been reached. We all remember that first filling, first extraction, first bridge.... but now...

My first grill! Yep indeedy. For those of you who are over 30 and/or oblivious to some of the finer points of hip-hop culture, a "grill" is a piece of mouth jewelry worn over the anterior upper teeth.

They were popularized by Nelly's '05 hit of the same name. "Smile fo' me daddy/ Let me see yo grill!"
(I won't quote the whole song, but mad props to rapper Ali for rhymin' "da bottom" with "Hillary Rodham")

Anyhoo, here's some examples!

And in action!

Here's the one I did (sorry about quality; i just had my cell cam on me!):

BLING!

I will admit that I had nothing to do with the external surface of the appliance - he just brought it to me and said, "Can you make it fit?" So there ya go. One more service offered. I'll let you all know when I come up with the ADA fee code for that.....

I originally tried to line it with Quick Bite, which is just a bite registration vinyl material. Too brittle. I ended up actually using VersaTemp, which is pretty strong but has a little flex to it. We'll see how long it lasts!

Oooh, Toothbrush recycling!!

2006-11-30T23:03:00.000-05:00

OK, So, after watching Will Farrell brush his teeth religiously in "Stranger than Fiction," I was cued in to the BRUSH he was using...it's a Recycline curved brush! check it out:

Recycline Products!

I'm so stoked. I can buy brushes made from recycled yogurt cups!! Whoot. Now, everyone can improve their hygiene whilst saving the earth. ohyes.

I can apparently order them by the gross AND get them imprinted with the practice name. Yippee ky yay!

HEY! If you're visiting from Yahoo Answers, Please, leave a little note! Would love to hear from you.

More dental hijinks to follow....

Dear Abby....

2006-11-17T00:26:00.000-05:00

...Hey, I just discovered the Yahoo interactive answer pages....
People ask all sorts of questions and those (hopefully) knowledgeable reply - and quickly! Very impressive. So I'm going nuts giving my (solicited!) opinion.

***If you are visiting my blog and were referred by the Yahoo site, let me know, leave a message! let me know what other topics interest you in terms of blogging and dental!

Anyway, and Yahoos referred here from there - Welcome!.

Others, go check out:
Yahoo Dental Questions

Later, kids!

CSI...shame on you...

2006-11-03T20:31:00.000-05:00

Sooooo, I'm watching the greatest show on Thursday night.... and there's this bit where they notice that this missing boy's grandfather is missing some teeth. They show a close up of upper Left part of the guy's mouth... he's clearly missing #6 and 7 or maybe 5 and 6. LATER, at an abandoned house, they find what looks like a 2 unit porcelein bridge... which is weird, cuz what's the point of that? if it's two units, why connect? the guy was missing two teeth, so it wasn't a cantilever.... also, when they showed the bridge, there was some sort of wire linking the teeth, presumably on the lingual.

BUT, it clearly wasn't like a Nesbit type appliance. That would look like a spider. So I think they just made it up and wrote off the intelligence of their dental viewing public.

Another time I was watching SVU and the "coroner" made reference to a deceased victim's "detention." Five minutes later I grasped they MEANT "dentition" and had butchered it...either the writer or actor and no one caught it. or cared.

That's why Finding Nemo was so good...They had an educated debate about the merits of Hedstrom v. K-Flex endo files! ooh, I get chills just remembering how my jaw dropped and I thought, "Wow...they made a joke that .003% of the population could grasp!" amazing.

yay my space....

2006-10-06T23:53:00.000-04:00

...so i have this random My Space page that I started on a whim (Dude! you're 30! quit it!) yes, I know, but still... who knows... well, today I found some friends from HS which is amazing cuz I'm SOOO not in touch w/ anyone from there. neato.

Sooo, Tiffany and or Rich...if you're reading this... HEY! check it out! I'm a dentist. how nutty is that?

Ahem. I have to maintain a level of professional propriety! (Which, admittedly, is tricky when you quote chapter and verse of Monty Python whilst performing oral exams....)

In the world of My Life, the practice continues apace. I'm going to see a chiropractor on Monday, which is a first, and an hour later I'm getting a MANICURE. Um, also a first.
After that, it's off to the bars with the rest of the flaming guys... Oh wait.... lol.

Seriously tho', I do some bad stuff to my hands, and worse stuff to my back, so hopefully i'll be all fixed by Tuesday. la.

anyway, talk to all ya'll later...

Extreme Makeover....

2006-09-25T10:42:00.000-04:00

.... Dental Staff Lounge Edition! Pow! Kazam! After watching non-stop TLC and HGTV, we assailed the back room of the office. Previously, there was an old rectangular table and four metal deck chairs. Some old dishes. Various communal snacks were in an old Crest box with torn edges, while magazines were stacked on a ledge off to the side. The only decoration was a picture of a lighthouse. (A good picture, actually, but kind of lonely...not unlike actual lighthouses, I suppose.)

Sooooo.... Several hundred bucks at K-Mart, TJ Maxx, Marshalls etc later (oooh! Expense account! yay!) we had new dishes, some racks to organize them, lovely baskets to organize magazines, tea and the like, a new bulletin board (the old one was just a large piece of ceiling foam, I think, like you place around your fluorescent lights...) two paintings of butterflies, three plants (one hanging in the corner, natch), new curtains and a small area carpet to lighten up the industrial rug. The recycling (a cardboard box, appropriately enough, I guess) and the trash are now identical white receptacles with flip-up spring-loaded lids. I replaced the regular clock with a square wooden homemade, hand-painted clock, which was a gift from a denture patient at the non-profit. It features some geese flying over a wooded pond area, and is quite good considering the artist is 79, and suffers from COPD and emphysema.

Most importantly, the Off-Price Furniture store had a nice little table. Lightly stained, it has two small drop leaves and two chairs; the other two are en route. My colleague, Dr B, dropped by whilst we'd replaced just the table and called my cell enthusiastically.... I said, Oh, just you wait.

Photos are hopefully forthcoming!

The unkindest cut....

2006-08-31T22:36:00.000-04:00

Sooooo, yesterday I had to let an employee go.

She was hired a week before I bought the practice and basically "wasn't a good fit" as they say. Not entirely fair, to be sure, but unfortunately as "prospective" owner I wasn't consulted when she was hired shortly before I bought the operation...

Anyway, easily the hardest thing I've had to do in my professional life, right after telling that one patient she had oral cancer....

What makes matters worse, was on the way home, I slowed down to pass a flashing-light cop car pulled on the side of the road....yup, it was her. Talk about bad to worse! Hopefully she told the officer why she might not have been driving well and he let her off!

On a slightly uppish note, the darts team was down 4-1 and managed to win 6-5 so I guess that was nice, but I couldn't help but be distracted. I guess I hope I never get used to that kind of thing.

laters all....

Time flies when you're being driven insane....

2006-08-26T01:21:00.000-04:00

Hello! not much pin-action here, tho' I recent trip to Ohio netted me some valuable face time with loyal bloggite (and hip, chic Reverend-A-Go-Go on the go) Don. Yay!

ok, after selecting www.newmarketdental.net (sorry dds.com supporters! that included Rachel for what it's worth....) our next decision relates to our (sigh) slogan. I think it's really more of a "tagline" but whatever. I tried to upload the future phone book ads, but I think it was too big a file and I'm too dumb to shrink it down....

So we have the header reading "newmarket dental" and beneath it reads one of two things:

A - {We make a practice of caring}
or
B - {Caring is our practice}

what we're tyring to do is emphasize that while we may not be the fanciest practice with bleeding edge technology, nor the fastest workers, we DO listen to people and treat them as more than a mouth with a wallet.

We don't try to force "ideal" treatment plans down someone's throat (that's what mirrors are for)...we meet them where they are, explain options and let people make informed decisions. Surprising how many practices don't follow that model...

So let me know what you think....

It's time for a Web Site! Vote!

2006-07-29T06:20:00.000-04:00

Hey, loyal bloggites! now's the time to have your 2 cents registered in my newest endeavor.

Having decided to name my newly purchased practice "Newmarket Dental," I'm working on the website.

(note: I realize Newmarket Dental exhibits all the creativity of Tarzan and Jane calling thier son "Boy," but I think for purposes of Google -ing, it might be best!)

SOOOO, www.newmarketdental.com is not available. we even tried to inquire to buy it but no response. hm.

I've considered newmarketsmiles.com, newmarketteeth.com, newmarketnhdental.com (awkward!), and even dentistinnewmarket.com, which one friend advised sounded creepily like an online personal ad..... "SWM dentist in newmarket, ISO friendly, educated "assistant." Must be proficient with suction. Non-flossers need not reply..."

anyway, we shouldn't go there, should we.... Anyhoo, we've settled on newmarketdds.com (which keeps the oh-so-popular Dot Com!) orrrr newmarketdental.net.

www.newmarketdds.com

www.newmarketdental.net

there ya go. Let me know what you guys think!

Official statement of Location!

2006-07-27T01:14:00.000-04:00

Hey - it just occurred to me that people might be trying to locate me on the web and since Newmarket Dental doesn't have a website yet (Rachel! Meghan! ahem!), I'll just mention it in case folks turn up here...

I'm at 80 Main Street in Newmarket. Phone number is ....well, just look in the book under Chris Batt. That's us! (new ad coming soon; worry not!)

here's some tags, just in case:

dentist blog

dentistry blog

nate swanson

nathan swanson

nate swanson

nathan swanson

dentist blog

dentistry blog

Get that f---ing thing out of my mouth, dumb---!

2006-07-20T00:58:00.000-04:00

...is what a 15 year old girl said to me today. She cried and whined...looked 19; acted 7..... cussed me out and gave the ol' "I don't want to be here! I don't want to do this!" OK, so leave. don't get yoru teeth fixed. but here's what's going to happen...more decay, pain, extractions or root canals.... "God! Why do you have to talk to me like I'm a baby!" ummmm.... "Well, I don't assume that people know all that stuff, so I try to explain it. i'm not trying to be condescending, but you deserve to know..."

"I'm not stupid!" oooh kay.... "But you said, 'I don't want to do this' and..."
"Why does everybody always twist my words! You guys are all the same."

Right.
So I was liek 30 seconds away from dismissing her from the practice in like, my second week. I had to put up w/ that crap in school and in the non-profit - But guess what, beeyotch.... I AM the man now, and you can't pay me enough to put up w/ that s--- from a teenager. a five year old, hey, they're irrational, I put up w/ some grief...even the 10 year old I had to pull a baby tooth on last week. fine. but not 15.

Anyway, when I came back, she actually said, 'OK, I'm sorry I was so rude.' which is good cuz it saved her having to explain to mom why she'd have to find another dentist. I may be wildly in debt, but I'm not that desperate.

Let me take this opportunity to welcome fellow Ohioan....um, i don't know her name. but she's a dentist and she's funny and you can see her link off to the right under You can't Handle the Tooth! blog. ta da!

Hank, we're currently watching all the DVDs of Six Feet Under....the one character dies (whoa!) and is ID'd by mandibular dental records (Actual line: "Maybe it wasn't really her! maybe she's not dead and someone else had the same dental work done!"); and her fam is in Cor D'Alene (sp?) so they go off to Idaho at the end of season 4 and it's all kinda country western decor and so forth; kinda funny, albeit inaccurate based on my experience.....

More pictures....

2006-07-08T14:19:00.000-04:00

The Lamprey River, right across the street:

Some other buildings on Main St (How cute is the skinny one on the left??)

The very charming Riverworks Tavern (below, left and right)

Breakfast spot

My Office!

2006-07-08T14:12:00.000-04:00

here is the new place! More photos to come as soon as i master the transfer process....

(notice the Italian pizza/sub shop next door! "Hey, Pietro....Yeah...How 'bout I comp ya the bleaching tray in exchange for free pies for a month?")

Minding my own Business

2006-07-01T11:37:00.000-04:00

Yesterday I spent much of the afternoon writing my new employees checks. Boy, I have GOT to get that process automated.... I had to tape the printout stubs to the envelope so the name and address showed through the window but not the amount of the check, so that was awkward. I guess previously there were checks printed off the computer on special check paper...

Another highlight was paying myself. Just wandered into the bank, whipped out a blank "starter check," wrote "Nate Swanson" in the upper left, pay to the order of Nate Swanson, signed it Nate Swanson and flipped it over to endorse it w/ yet another Nate Swanson signature. Ta da! I thought, "Hm, I hope I can afford to pay me that much." Then I figured I can't afford to not pay my mortgage, so there you go.

Rachel and Co. at Espiral are cranking away at my dental logo... we're hoping for something that conveys a retro-chic look (since the practice was established in the 50s, originally) or more of a "vintage" look to channel the look and feel of ads and store signs from the late 19th, early 20th century. We're hoping to convey a "traditional" and "small town" look that will reflect my philosophy of giving patients quality, personal attention, even if we don't necessarily cater to the "spa dental" clientele with lasers and other such gee gaws.

Goldurn consarned "esthetic dentist" whippersnappers!

On the other hand, we don't want to imply old as in technique... no one wants "Medeival Dental."

We did decide to call the new office "Newmarket Dental," figuring that will be most logical for Googling and so forth.

check out Newmarket, NH Web Site for a reference....

We thought about "First Falls Dental" (which sounds like someone will fall and chip a tooth) and other River related names....the River is the Lamprey, and surprisingly, "Lamprey Dental" is taken. Folks 'round here just associate it with the river, but I still don't know about the connotation of having your patients think about you in the same way as blood-sucking eels.

Any "river" reference was nixed as being trite: Riverfront, Riverside, Riverbend....

Everyone was tempted by "Main Street Dental" as the practice is on, well, Main St., but that was, unfortunately, taken by another office in New Hampshire, albeit 80 miles away.

Lastly, I liked Branscomb Dental, named after the Branscomb Inn & Tavern. The building the office is in is around 200 years old or so and that was the name of the business that occupied the building during the stagecoach days. Neat! But no one would get that. "Well, actually, no, there is not now nor was there ever a Dr. Branscomb...." So.

BUSY!

2006-06-18T14:12:00.000-04:00

OK, in case anyone was wondering....

My parents were visiting a week ago, stopping in Kittery en route to their visit to Munich, Germany.

Also, I'm getting ready to buy a practice. Yay. I'll fill you in the the details once the deal is signed and it's all "declassified." heh.

More later!

Sad...

2006-05-31T22:14:00.000-04:00

I was recently informed of the loss of a former classmate.

I met Lori Powell when I moved to Ohio for my junior year of high school. She played the French horn in band, orchestra and a few other musical groups in which I was involved. She was a year ahead of me, but much friendlier to the "new kid" than most in a fairly insular community.

Her father is a physician and she thought about going pre-med - I was leaning in the same direction, so when I looked at colleges, I ended up following her to Calvin College in 1994. She decided on biology/education, while I parlayed my bio studies to pre-dental. My junior year, she was in a terrible accident. You can read a bit more about it here on Calvin's prayer forum.

Amazingly, I was on the road the same weekend with some friends, on a ski trip, and we chuckled over some near misses. Upon arriving back at school and hearing about the accident, I found new relevence to the expression, "There but for the grace of God go I..." which really bothered me, since all the students in the accident were really GOOD kids...why not me?

Anyway, Lori lived with her family, who cared for her due to severe brain injuries sustained during the accident. I remember when my brother, Peter, died, Lori's brother, Justin, was at the viewing. He was in band with Peter as I'd been in band with Lori and he let me know that his family was praying for mine. At the time I remember thinking that I wasn't sure which family was "worse" off....mine for losing a 14-year-old entirely, or Lori's for "losing" the life she had had as she prepared to graduate from college and become a teacher. You can study life and you can study what it means, but you can't answer those questions....

Lori died this month following a bout with virulent pneumonia. I have to believe that she had a key influence on:
1 - keeping me sane in high school
2 - my choice of college, which, philosophically and educationally changed my life on a daily basis
3 - my decision to pursue health care as a career.

I know that Lori's family has no doubt that they will be reunited with their daughter after thier own passing. But if you're so inclined, I'd encourage folks to remember them in their grief.

Sour notes

2006-05-24T17:09:00.000-04:00

As mentioned in my previous post, we in New England suffered a fair amount of flooding due to a recent week-and-a-half long rainstorm. Six days into it, I was prompted to stand up at work and declare, "I don't know who it is, but someone is making God angry, and they need to stop whatever it is they're doing..."

I swear, while everyone else was making a run to Home Depot for sump pumps I was online pricing arks. The arks themselves aren't that pricey, but boy, try finding a slip at a local marina.... oy.

Among the casualties of the basement flooding were several well-organized stacks of notes from dental school. Soaked right through, and a week later starting to smell a little gamey.... So I hucked 'em in a neighbor's pickup to run to the dump.

Actual fact: If you own a pickup and live in Maine, you have to have the back seat full of duct tape and a dog. If you borrow a pickup, those items actually come with it. As Dave Barry would say, "I am not making this up."

"Um...look, I just need the truck for half an hour, so if you want to just take the dog an..."
"I don't think you understand....Truck goes to the dump; Cooter goes to the dump."

So now that I'm done washing various Cooter fluids from my clothes, I have time to reflect on my dump experience.
I wanted to at least recycle the papers (as soggy as they were) which meant pulling them out in sheaves and removing any bindings and rubber bands that held stuff together. This gave me the opportunity to ruminate on the dental school experience. I allowed myself to wallow in nostalgia whilst Cooter wallowed in some nearby hamster cage shavings.

On one hand I felt pretty bad throwing the stuff out. Page after page of notes, representing four full years of my life. Most of them had notes written by me, and many of them had been read multiple times in preparation of studying for quizzes, tests, etc. Most amusing were noticing things that I wrote in margins.

"To Rent: 'Shakiest Gun in the West;' stars Don Knotts as cowardly dentist."
"Dental Fraternity Initiation questions: -Which of the following dental instructors is NOT gay......; -How many tabs can be found in amalgam shade guide?..... -What is the specific name for an oral lesion resulting from trauma sustainted during sexual activity?"

Also included were potential designs for the tattoo I never got. So many memories and dreams, lost forever.

On the other hand, contrary to the maudlin feelings of bittersweet remorse, there was a clinical detachement and even relief tossing the notes. Just one glance at a packet of handouts from Immunology was enough to hurl it into the recycling bin. If I ever again need to diagram the histamine response, I suppose I'll be up a creek. Further, I enjoyed the warm feeling of de-cluttering. I mean, really - what was I going to do with all those notes? Dig 'em up in 20, 30 years and show 'em to my kids? "Hey, check out what I learned in dental school back in the day!" Even if they CARE about dentistry, no one would want those notes.

That said, I do still have all my text books, safe and dry at work. I remember finding one of Grandpa's old genetics texts from the 40's. It's quite....Mendelian. That is, pre-dating Watson, Crick and Co's discovery of DNA as the units of heritability. "There is currently some interest in this little nucleic acid, with some researchers thinking it may perform a key role in genetic tranferal," reads a quick blurb at the end of one chapter. So who knows.

Having spent nearly 3 hours on a root canal this morning (patient was on nitrous and actually unaware of how much time passed!) my wrist is sore and I'm pretty much tapped on for typing. Adios, amigos.

Soggy, but unbowed...

2006-05-21T12:24:00.000-04:00

Hello, loyal bloggites! Sorry I've been AWOL of late, but I've been rather tied up with the Extreme Weather we suffered from here in New England. In an attempt to emulate Old England, we had NINE days of nothing but rain, with the attendant flooded basements etc etc. Six inches of water seems pretty bad, but on TV I saw folks who had four FEET or more of water, so I can't complain. Things are dryer now, and sunniness is abounding.

On the dental front, I spent a couple days last week jamming in Meredith, NH with the annual meeting of the New Hampshire Dental Society. As President-elect of the Seacoast regional component, I have massive responsibilities, which seem to involve showing up to some meetings and attending a dinner or two. Being the youngest dentist in attendance led to fun questions about my "demographic."

"It's great to see you here... but what can we do to encourage other young dentists to join/participate in the society??" was the question du jour. (The soup dujour was a lobster bisque; stunning!)

Anyone else ever get that? The assumption that you, as the only minister or woman or Asian or homosexual have some sort of insight into the behaviors of hundreds of other ....er, well, lesbian Japanese preachers or whatever. OK, that IS a bit of a restricted group but nevertheless.

I tried to explain (while sitting at a table w/ the past president, new president and president-elect of the state society and their wives) that a lot of people don't participate no matter what. Look at how high the stakes were in the last election, and we STILL only got 50-some percent of eligible people to vote. Time Magazine pointed out that of 18-26 year-olds, 38% thought that voting for American Idol was as important as for president. So there's a participation piece and there's a misplaced priorities piece.

I am, by nature, a joiner. If you have a band, and I play the trumpet, I'm signed up and ready to toot. Others would rather take a walk, read a book, write poems or watch TV. Regardless of the worthiness of their alternative pursuits, they don't JOIN.

Secondly, I said, there's an assumption that somebody else will take care of whatever. A bit reason for involvement in professional organizations is to represent in a somewhat united front to legislators and the public. Important decisions are made and someone has to stand up and explain where the group stands. Typically, it's more experienced people, but you have to get others involved at some point.

So I don't know if I could help them understand where the other 20/30-somethings were. I'm kind of an odd duck anyway, so I'm not the best person to ask.

Quote of the week: "I have no discipline whatsover. I don't even floss! I'm 35 years old and I've had four root canals. Four root canals!! What the hell is wrong with me..." - Nate Fisher, "Six Feet Under"

We're watching the whole series on DVD start to finish, if we can. Pretty good stuff, tho' watching, say, three episodes in a row leaves one thinking about death more than may be healthy. Hence the characters' oft-troubled psyches, mayhaps.

The episode that whacked me out the most featured a decedent named Swanson, which name was occaisionally juxtaposed near regular character Nate. I got really confused.

...while juggling chainsaws

2006-05-07T09:31:00.000-04:00

Friday provided a new highlight for my career. I did two (yup, dos, duo, deux) fillings on a young mother while not one but TWO small children sat in her lap.

How, in the name of Don Knotts, Tim Conway and Moe Howard, does this happen? Why would the dentist allow it? And what would possess any mother to think, "Hmm...sharp objects and high speed rotary instruments running around my head...what could be better than a 2-year-old along for the ride?"

Well, Mom brings in kids and they're kinda antsy and if she sets them down blah blah blah. I suggested, "Hey, maybe Jen at the front desk could keep an eye on them for a bit." "No, I wouldn't wish that on anyone."

Except me, apparently. Anyway, this mom had never had a cavity, and they were both really small (we thought) so I wasn't initially going to bother with anesthesia. (Don't gasp - if you've never had this down it either means your dentist is paranoid, overly destructive or that you or s/he wait too long to actually get the work done. Not a big deal; it doesn't hurt and people are happy to avoid being numb for 3 hours.)

So, back goes the chair, which the kids are pretty excited about. After a couple minutues, however, watching mom's mouth becomes less exciting and the chair becomes a slide. Er. Jimmy the 2-year-old gets squirmy and mom grabs his ankles to prevent him from escaping. "Sit still, Jimmy and just suck your thumb. Good!" Um.....oh, never mind.... Mom taught me to pick my battles and I'm gonna let the digit habit slide here for the greater good....

Turns out the one tooth is just chock full o' decay (wouldn't that be a great coffee? mmm) and I decided she needed to be numb. Again, the boys are fascinated. To be fair, Davey the 5-year-old was pretty good the whole time - totally fascinated by the ultraviolet light and other goings-on. "Whoa, Mom! Your mouth is GROSSS!!! Ewwww! (to me) How can you go IN that ugly mouth?" which sets the record for youngest person to ask me, "How can you look at mouths all day?" I told him to mind his manners and that his mother has a very nice, pretty mouth, which instantly made me a bit edgy."

Dad: So how was the dentist's?
Mom: Well, I don't think I'll bring the boys next time...
Davey: He said that Mommy has a pretty mouth and we all sat in her lap!

The above scenario may or may not have transpired, but hopefully not, as I met Dad the day before and he could totally kick my butt. Anyhoo, we finished up ok and mom did, in fact, express her desire to "not do that next time" so at least she saw the error of her ways. And on the positive side, the kids (or at least Davey) got a very good first impression of operative dentistry. If I know the patient isnt' going to freak out, it's great to have the kids watching for future reference. Just not from the lap.

Vote for Rachel

2006-04-29T16:23:00.000-04:00

Shout out to college pal Anastasia Tuckness (nee Niefhof).... The following has nothing to do with dentistry!

The talented ladies of Espiral Design have submitted a logo for Portsmouth's Market Square Day. Among 40-50 entries, they were chosen for the Final Four. It is now up to Seacoast newspaper readers and internet denizens to select the winner.

Please VOTE HERE!

I don't think you can vote multiple times from the same computer, BUT if you happen to have a couple at work, it wouldn't hurt to do so from different terminals!

There is a cash reward for winning, but the exposure would be the best thing for a young design company.

Also, you should take the time to appreciate that it is NOT just your typical square logo... I said, "Hey, wouldn't a more squarish...."
"NO. You clearly don't understand contemporary design."

So there ya go.

Vote. Tell your friends to vote.

In Response to Don

2006-04-20T00:09:00.000-04:00

First of all, the Easter service we attended this church was lovely...the pastor apparently started there in '03, so I was like "ooh, look who's been at his profession LESS time than me?! ha! Hey, kiddo...you old enough to preach?" Sorry, I've been waiting to dish that at someone for four years... But he has an earring, so I thought of Don. Also, he preached from the end of Mark, and was happy to point out that the concluding text (after "and they were afraid") was all added a coupla centuries later. So I thought, wow, that's pretty ballsy.... shooting down the inerrancy thing in the first 2 minutes of your Easter sermon! But he did a great job tying the whole piece together so as to not be detrimental to the Ressurection and the faith as a whole. Kinda cool.

Don says, "This wave of anti-smoking legislation has come as the result of those of us who do not feel we should have to breathe others' smoke saying, "If they want to smoke, fine, but I should not be forced to breathe it.""

True. But you don't have to breathe it. There are tons of non-smoking bars that you're welcome to go to, just as there should be smoking bars for smokers. Most of us aren't so inclined to watch naked women dance, SOooooo we don't go to Club Secrets. (inside Columbus joke; I was sad to see that place go, cuz every time we drove past, Rachel or I would say in a cartoon-like falsetto, "NEEWWWdie bar!".... not unlike Randall in Clerks says it.)

I've gotten to the point, now that I'm "old" that I don't care to watch college kids "dancing" at their "clubs." So I go to other clubs. I feel we should let the market decide. If all the hospitality employees STOP working at those smoking facilities, then they'll go under. If no one patronizes them, same deal. -I- for one would like people to stop attending knee-jerk right-wing fundamentalist "churches" like Rev. Phelps' in Kansas, but I wouldn't suggest legislating against people attending the church of their choice (even if they do espouse hate.)

My point is: are smokers really SO bad, in their limited bar-space left to them that you have to force them outside to freeze in 15 degree weather during the winter? Granted, smoking under those conditions is doubly ironic, as A) you have to have your fingers extended to grip the butt (ha! I said grip the butt...) which makes them colder and B) the nicotine causes peripheral vasoconstriction, thereby making them even COLDer. Funny, ironic, but mean, I think.

Yep, Don...the Cerec machine has been in existence for at least 10 years, I believe; they're on the third generation of it now...or maybe the fourth. Bill Thompson at Grandview Dental has one and my mom has a couple of those crowns.

I didn't hear the NPR on amalgam/composite, but I did read a new mailing from the ADA that sites some new J. of the Am. Med Assoc studies that provide MORE evidence that the mercury therein does nothing to harm kids behavior, learning and cognition and their kidney function. So.

Last thought: How many of you would think it's odd if you went to the dentist, and instead of telling you if you had cavities or not, they said, "Well, we'll look at the xrays later and call you if anything shows up."? just curious.

Public Health vs. Smokers' Rights?

2006-04-14T08:03:00.000-04:00

Soooooo..... It has come to this. After some comments on the last post regarding smoking, I will address this peculiar little issue.

Due to what I call the "situationality" of the issue, I really have no problem with smoking in bars and some restaurants.

Yep. There ya go.

Situationality? Sure. There's situations where otherwise incongruous points of view collide. Example: Howard Dean (whose campaign I labored for mightily back in 2003-4) is a big supporter of gun rights. Situationally. That is to say, the possession of firearms by farmers in Vermont and adolescents in NYC is quite different. The church I attended in Ohio had a few "log cabin Republicans." These were otherwise intelligent, educated folks who voted Republican. OK, the latter description includes my dad...did I mention the Log Cabin folks are GAY? Yup. But, for situational issues, they prefer to side with the party that one would otherwise assume they would not.

So. The anti-public smoking camp says that they are merely looking out for the health of all those poor wretches who are forced to wait tables and sling beers in (*gasp! koff!*) smoke-filled environs. Shouldn't we be protecting them from second-hand smoke as we protect dental assistants from excess radiation? Perhaps, but I have yet to meet such a restaurant/bar employee who isn't a smoker themselves. For heaven's sake, -I- had barely even picked up a cigarette 'til I started waiting tables back in the day. Then you discover you get an extra break to participate in a vice. How much sense does that make? I mean, could you be waiting tables, and then say, "Yo, Jim - Cover my section; I'm gonna run out back and masterbate and pick my nose for five minutes." Yet smokers get breaks when they like.

Thus, I don't buy the "save the employees" argument. I also don't buy the "let's protect the public who wants to dine without gross smoke by their food." If I'm dropping $25 for an entree and $12 for a glass of wine, you better believe I don't want smokers around. If I'm paying $5 for a truck-stop breakfast or I'm just drinking beer and grubbing pub fare, I don't care.
And even if I did - Guess what? There are plenty of smokeless alternatives to go to. I DO recognize this is not the case for dart league, although most players are courteous enough that if someone says, Hey, can you not smoke within 10 feet of me, they'll comply.

Now, New Hampshire (whose House passed and Senate rejected a smoking ban in restaurants) is the Live Free or Die state. I'd be more indulgent of a paternalistic "let's make everyone quit" philosophy if they started...oh, I don't know... Making people wear seatbelts! or motorcycle helmets for cryin' out loud.... How likely are you to die being exposed to second-hand smoke? Possibly more likely than otherwise, sure, but when you compare that to how likely you are to die by not wearing helmets/seatbelts..... Until you've seen those charming photos of ER patients who are scraped off the road or out of their cars you really don't appreciate that.

My feeling is that until we can prevent people from consuming sugary drinks and eating fatty meals, trying to legislate less smoking is foolish. Concentrate on preventing it in high school and providing smokers with resources and support to cut back or quit.

Have at it. :)

That's DOCTOR Caveman to you, Bub!

2006-04-05T17:56:00.000-04:00

The latest from Yahoo News:

9,000 Year-old Dental Drill Found

Somewhere, a bunch of hungry Sullivan-Schein reps are placing eager calls to Pakistan, hoping to make a sale. "Oh, that doctor is BOUND to want the NEWest Kavo handpiece!"

My favorite part of the article is where the anthropologist says, "I showed the pictures to my dentist and he thought they were amazing holes."

To my patients: If you ever want to share "amazing holes" with me, I'd just as soon you not.

Anyway, I know that ancient Native Americans (and perhaps Egyptians?) used to hold their heads over incense to "smoke out" the evil spirits or tooth worms which presumably caused toothaches. It turns out that the herbs in question had hallucinogenic properties or narcotic properties, thereby "curing" the toothache, or at least relieving it for a short time. I'm not sure when hashish was discovered, but it's mentioned in Arabian Nights, so who knows how those people may have relieved pain prior to fillings.

Depending on the age of the patients, too, a minutes worth of drilling, up to 2-3mm, might not be SO bad.

I had a 16-year-old yesterday w/ a small amount of decay on a molar. I said, "OK, let me know if you feel anything; this isn't worth getting numb, but if it bugs you, I can do so." Soooo, being all hepped up on Mountain Dew and such, he didn't say anything. "You OK?" "Yeah." When I was done (maybe 2mm, which is 1/2mm into dentin, and therefore probably sensitive), he says, "Oh, Dude, that, like, hurt the entire time. But I didn't say anything."

Tempted to cite one of my mother's favorite sayings, "So do you want a medal or a chest to pin it on?" I replied, "OK. Nice work, bud."

Days without patient swallowing precious gold restoration: 13!

Spitting is better than Swallowing

2006-04-03T00:08:00.000-04:00

Fun and games.

Went to ER last week due to Rachel having a Pilonidal cyst (check out pilonidal.org for gory details) - nothing like being asked "Does this look infected to you?" OUTside of work. So that's all better, having had it drained. (Gooey!)

(Aside to Rev. Wallick - now a higher risk of Crohn's, acc to the ER phys. asst - interesting)

Monday there was a bat in the house. Always fun to toddle over to the neighbors (hi Matt!) and say, "Um, yeah, have you got a fish net?" at 11pm.

The most FASCINATING thing to happen to me was an experience with a patient who ate a crown. (actually an onlay, but we won't get into that)

This is a fascinating lady who is a hoot at cocktail parties, I'm sure, but, by her own admission a "pain as a patient." (I did NOT say it; she did....) Anyway, upon trying this crown in, I put cement on it, seated it, had her bite and said, "Stay biting for a few minutes." For SOME odd reason, perhaps it was the nitrous, she elected to OPEN a few seconds later. As she moved her tongue around, and I looked on in horror, I saw the crown (onlay! less retention..duh...) dislodge and float around her pharynx area for a few fateful seconds.

Springing into action, I whipped off the nitrous, pulled her head to the side and encouraged her to cough. "Turn! cough! couch couch! Go aaaugghhkk!" (the latter word is MUCH better when I tell the story in person, as people say, "oh, how was that again?" in a facile attempt to make me go aaaugghhkk again)

She did not aaaugghhkk. She went, "glug...gurrr...ack....GULP!"

Down it went, as I futilely attempted to fish it out with a cotton pliers (dental tweezers to you lay people).
"Oh," she remarked, "a piece of something went down my esophagus!"

Oh, not just a piece, but THE something. After making sure she was breathing ok, I walked out of the room so as to avoid the temptation to either grab her by the throat or bash my own head against the wall in frustration. Certainly I could have been more watchful that she didn't open and sure, I could have had a 2x2 gauze there to catch it if it fell. (although, YOU try to leave gauze adjacent to #2 AND have the patient close and then you'll really see gagging!) Nevertheless, I thought, "Oh dear Lord, I SAID to BITE!"

After returning, I encouraged her to eat plenty of fiber, Metamucil, what have you. We'll get her back in 2 weeks after the lab makes a new restoration. "In the meantime," I said, "you will be pooping out gold. We should all be so lucky."

"What if I get it back?" she asked. Er. You mean....retrieve it....er, AFTER? "Sure!" Well...um....

Actually, I DID recement a lost aka swallowed crown back in school....just ran it through the autoclave, tho I learned that when a patient hands you ANYthing you want to probably have a glove on.

Well, on Monday, she called and reported that after dining sumptuously on Mexican food all weekend, she RECOVERED the restoration. All I could think of was Trent Reznor of Nine Inch Nails singing that one line, "I wear my crown of s---/ upon my liar's chair/ full of broken thoughts/ I cannot repair." (of course, the Johnny Cash version is not only a more powerful song, but he manages to clean it up, "I wear my crown of thorns.")

So, after some sterilization, we cemented the bugger right back into place. Only took 2 hours this time. I was careful.

Adios, amigos.

Madness, I tell you....

2006-03-19T09:35:00.000-05:00

Ahh, is there any better time than March Madness season? If there is a better confluence of sports, slacking off, beer and excess, it's gotta be getting out of work at noon and sitting in a sports bar watching four basketball games while drinking Guinness on St Patty's day with a plate of corned beef and cabbage on it's way.

Working in a primarily all-female environment, I find some difficulty relating all this excitement. One of the hygienists, a man (who is SO much cooler than Ben Stiller's Nurse Fokker) keeps me sane. But some women are tricky regardless. I'll come into work all excited about the Olympic figure skating short programs and did anyone watch it? Nope. They were watching American Idol and Dancing with the Stars. Hey, new Pride and Prejudice film out.... who's seen it? No one; they all went to see "Stealth" or "The Hills have Eyes." Sigh.

Currently, however, my pool is being won by our friend Cathryn, who based close decisions on "Do I know anyone there?" Thusly, you have her brilliant predictions of Montana defeating Nevada and Washington squeaking past Illinois to the Sweet 16. With 25 correct picks in the first round, she's 4 up on ESPN's Joe Lunardi and 6 ahead of Sports Illustrated. So hah.

Rachel continues to ride Gonzaga deep into the tournament. I say, "Every year they disappoint you! Why do you keep picking them?" "Well, if I DON'T pick them, then that's the year they'll win it all!" Sheesh. Gonzaga: the abusive ex that you keep hooking up with, even after the relationship is irreversibly flawed.

In other quotes from R: "I think it's good that Kirby goes in the shower, cuz then at least it cleans his butt."
No one likes a cat that's too...er, hefty to reach his own posterior for cleaning.... sigh again.....

Wow...she MUST be bored

2006-03-12T11:33:00.000-05:00

At the tail end of the conversation on Southern Ohio, a certain first-time poster called "Rachel" wrote, "Wow...I MUST be bored. :) luv you nate..."

Well, I appreciate the love, but.... Seriously, only the painfully bored would POSSibly read what I have to say! YOU are blessed to be exposed to a consistent stream of charmingly whimsical Nate-isms. You should be more symmpathetic to the vast Nate-less populace that has never had the opportunity to bask in Nate-ness all the time, or harsher still, those who have experienced a brief, shining moment of Nate-aity and then had their Nate from their bosom untimely ripp'd.

(The latter is a shameless "rip off" of MacBeth, Act V, scene viii, in case the phrase resoNates with anyone...)

In other news, check out the progress of Ohio State basketball. Go Bucks. Whoot.

Have you ever wanted an Angora rabbit? I haven't. Rachel thinks they're "cute 'n fluffy." blegh!
check out Ernie the English Angora. You have to scroll past Oscar the Pug, which is a freakishly odd pet, but only relative to dogs.

Also, the ljc blog is charmingly whimsical and I recommend it to everyone.

off to Brunch!

Gasp! Mercury!!

2006-03-07T20:03:00.000-05:00

So, a couple weeks ago, the award-winning local daily put this article on the front page.

Pretty standard alarmist stuff. I was mad that although they quoted the directors of local dental societies, who ostensibly represent dentists, they didn't bother going to the trouble to find an actual dentist to discuss this issue. Oh, they found Dr. Fischer, "past president of the International Academy of Oral Medicine and Toxicology." His site, which I won't even justify with a hyperlink (google if you like) discusses the imminent danger not only of silver fillings but of fluoridating the water.

Now here's my deal. If someone asks me not to use silver fillings due to concerns about mercury, I'm OK with that. Better safe than sorry, maybe (even tho', as all dentists know, there's no scientific evidence to support the "silver fillings will hurt/kill you theory). Hey, I personally have an unproven superstition that if you hit the "To Cross" button at the crosswalk an even number of times, it will DEactivate the signal. (On...off...on...off) So I always do it 3-5 times.

But when you get to the anti-fluoridationists, I just get mad. I can respect anti-mercury filling people despite their lack of evidence. But the others.... wow, they feel compelled to lobby against the single most cost-effective public health practice on the planet, thereby primarily harming those who can least afford it: Uninsured children, or kids with non-compliant parents.

The other thing seems to be the way the article is structured. They lead off with all these super-scary mercury facts. THEN, at the END of the article, the opponent of mercury fillings states, "We can’t say it will cause harm, but we know there is no benefit."

We can't say it will cause harm, but.... Kinda specious, in my opinion. The SAME poll they use (Zogby) states that of those patients who actually discuss fillings with their dentists, more than HALF feel that they'd be likely or somewhat likely to go ahead and use silver if necessary. Not reported in the article. Thbbt.

Ah, Southern Ohio....

2006-02-25T19:08:00.000-05:00

First off: No lurking! If you are reading and enjoying (or even reading and hating) please leave replies! Otherwise I'm forced to assume no one cares and will be forced to sit around wondering why everyone insists dentists have such a high suicide rate. (not actually true; in recent years we've been surpassed by lawyers...)

This post is almost verbatim copied from a recent email exchange with a dental school colleague who now finds herself working in Southern Ohio. (This is, I'm sure, less stressful to her than finding herself, due to vagaries of surnames, sitting next to ME for four years...heh heh...)

Anyway, thanks to Dr. Janice for her inspiration - I wish her the best of luck in joining the small but significant demographic of "NASCAR-watching Orthodontists!"

As you may recall, I spent 3-4 mos working for
[non profit healthcare agency] in [Appalacian Ohio town]; had some good assistants
from [slightly larger town]... I always remember things from that
practice like:

"Bubby don't much take ta sleepin' without his
Mountain Dew, ya see..."

On back of a truck: sticker featuring Osama bin Laden
saying "F--- you A------." That way, when al Qaida's
leader is tooling around Appalachian Ohio, he will see
that, realize he's an a------ and that he can get
f---ed.

On blackboard inside Waverly restaurant/tavern:
"How's a Pike County divorce like a tornado? answer:
Either way, someone's losing a trailer."

Also noted on backs of trucks (it was eerie thinking that my Toyota was the only one for miles around...)

-Keep honking; I'm re-loading.

-(in the style/font of popular milk industry slogan:) gut deer?

- "Terrorism" - just that, w/ an 'anti' ring around it, like the "no smoking" sign or the Ghost Busters logo.

I saw the latter in a parking lot one day and mused, "Ya know, that really makes me stop and think. Cuz ya know, before I got into dentistry, I was totally going to BE a terrorist! But now...I'm just not so sure..."

Needless to say, I was hardly surprised to find John Ashcroft trailing me around for a few days...

Fond memories - I always referred to the area as a place "with more
guns than teeth."

THAT said, I was always impressed that a lot of young
parents with kids were pretty determined to keep their
offspring from losing all the teeth that THEY had; they kept
their appointments, listened carefully to your
instructions and were profoundly grateful for the
services. If Bubby or Sissy weren't brushing enough,
you can belive mom and dad would be letting 'em have
it on the way out the door....

so there you go.

Serious as Cancer

2006-02-19T14:43:00.000-05:00

Friday I spent the afternoon "riding shotgun" with a local oral surgeon. Usually it's fun (for me anyway) to watch someone w/ the skills to shuck out four wisdom teeth in the time it takes me to do one. Today was a little different. He was kind enough to see a patient from the non-profit who we were pretty sure had oral cancer.

The slim, middle aged woman is "between homes," as we say, but had recently started a new job and was pleased to be getting health insurance. Unfortunately, even though she'd noticed the sore in her mouth a year ago, and even though there were resources to assist her in seeing someone, she "put it off because I didn't WANT to know for sure...I was scared."

Increasingly, the difficulty swallowing increased, the pain under her tongue and in her jaw became more severe and frequent, and she finally sought help. The ulcerated, bulging lump ventral to her tongue and the nodular involvement appreciable in the submandibular and cervical areas were hardly subtle. Even the greenest dental student would raise an eyebrow with the symptoms and presentation.

While waiting on the oral surgeon, I made small talk with the patient. We both had family in Ohio. Our places of employment are nearby one another. Yep, it sure is windy today.

The oral surgeon confirmed our suspicions without needing biopsy. "T3 or T4," he said, soberly shaking his head out in the hallway. "I'm sending her to Dr. ---- in Boston. She needs a head and neck surgeon - probably radiation, maybe chemo...."

We returned to his exam room to try to gently tell the patient that we would do what we could to facilitate her treatment. "Can I wait 'til my insurance kicks in?" she asked hopefully. "Two months?" my colleague said incredulously. "Ma'am, I don't want you to wait two weeks. We need you down in Boston next week." He wrote out a script for a strong narcotic so she could sleep at night.

Dr. ---- was in surgery, so the oral surgeon dismissed the patient, promising that his office would call her as soon as they reached the Boston doctor. I shook her hand as compassionately as I good, encouraging her to not hesitate if my agency could do anything to facilitate her transportation or other needs. She left smiling unconvincingly, with a hint of tear in her eye.

It's easy to scoff at people for smoking too much or not seeking care. Harder when the person has a face and a family. I wish she'd come in sooner.

A Million Little Root Canals....

2006-02-12T11:53:00.000-05:00

Much furor has been expended over the "embellishments" of James Frey in his "memoir," "A Million Little Pieces."

For those not tuned in to All Things Oprah, a brief synopsis: Mr. Frey wrote a book detailing a horrific and harrowing experience with drug addiction. It was, fiction or not, moving to many people, including Oprah and her Harpo cronies. They selected it for her Book Club, which is pretty much the writers' equivalency to winning American Idol. Possibly better.
I've heard the author even sold the movie rights to Brad Pitt. (Paging Tyler Durden...)

Eventually, a number of discriminating readers started to question the somewhat incredulous claims made in the book. Several pilots, flight attendants and others in the airline industry said, "Hey...you can't put someone on the plane who is unconscious (and bleeding and covered in bodily fluids) without a doctor...you just can't do that! No one does that..."

People started asking questions. Eventually, Frey admitted the book isn't so much about fact as "impression and feeling."
see his statement from the publisher's website

Now I don't mind a little literary license, but Mr. Frey is doing the dental equivalent of shouting "Fire!" in a crowded theater.

Read this account from a Pennsylvania dentist regarding the absurdity of the story!

While I'd been previously just irritated or amused by this whole brouhaha, I am now of the state of mind of those offended by Denmark's cartoon depictions of The Prophet. He has basically tainted the water for thousands of people who are already paranoid about dentists and now have yet another reason to avoid needed treatment. He has in effect, contributed to others' suffering. Why? Because of an impression.

Look, if you want to say, "Wow, that last exam was brutal - Professor Smith totally f---ed me up the a--!" that's fine, but if you do so in such as way as to imply that you were ACTUALLY sexually abused by your teacher, it's irresponsible.

I have treated dozens, possibly even hundreds of addicts, recovering and otherwise. When I worked with Narcotics Anonymous, I found that they were terrific patients. Right around step 7 or 8, whilst making amends, many of them decided to address long-ignored dental concerns. Transitioning back to the job market, they usually had plenty of time for visits (even a long visit with a student dentist!) and appreciated the reduced fees of being at a teaching institution. They never asked for narcotics, and despite how drug-addled some of their brains might have been, I never encountered an addict so foolish as to think that local anesthetic could get them high or cause a relapse.

I've thought about the concept of triggering our natural fears of dentists in the pursuit of art, and decided that I don't really mind that pursuit in a fictional setting. Marathon Man and Brazil are films where people are tortured by dentists for dramatic effect, while Little Shop of Horrors does so for comedic effect. But no one ACTUALLY believes that this is what will happen at the dentist any more than one fears being eaten by carnivorous plants at the flower shop.

If you need me this weekend, I'll be the one out in Market Square, burning a copy of Frey's book.

Telling it on the Mountain

2006-02-10T18:54:00.000-05:00

Hello - as promised, I will (briefly?) discuss my last trip to the cinema to view the critically acclaimed Brokeback Mountain. Although overhyped a bit, it's definitely an excellent film - touching without being overly manipulative. By the end, if you didn't feel the longing and frustration and sorrow experienced by several characters, you probably don't have a heart.

One nice aspect of the film was it's sparse style - the dialogue and pacing often resembled the spare but beautiful scenery. A lot was said by what WASN'T said or even there.

My biggest impression is that you could basically write a book based on audience comments whilst exiting the theater.

From some girls about 10 years younger than me, in regards to a "skinny-diving" scene where the guys jump naked off a cliff into a lake: "Um, hello...I would have been ok but what was the deal with all the flapping genitalia? ohmigod!"

It took a great deal of self-restraint to resist saying, oh, i don't know... "Well, ladies, I don't want you to be TOO surprised on your wedding nights, but let me explain a few things..." or even "Hey, let's try a little experiment. Go take a running jump into a lake (topless) and then we'll talk about who's flapping...." la la la....

and then there was the inevitable: "Ya know, I was pretty much ok w/ the love story but...c'mon, it was two GUYS!"

Um. let's see. That earns a big critical blank stare and head shake from this movie goer. I mean...duh. that's like when I saw some young ladies leaving Saving Pvt. Ryan some years back going, "Oh! I just wanted to see Matt Damon...I didn't realize it would be so VIOLENT!"

All ya had to do was read ANY snippet of any article or see any bit o' TV or hear anyone at all talk about it and the words "most gorily realistic cinematic portral of war EVER" would show up.

Anyway, what I found most interesting was how the two leads were both quite functionally bi-sexual. Most gay men I know are, realistically, as repulsed by the notion of sex with a woman as straight guys are by the possibility of a homosexual encounter. Or at least that what people say - obviously Kinsey & co. feel that everyone is on this continuum....

Anyway, I don't have any more pithy thoughts on the subject, but will welcome comments and discussion!

I'll try to get back to more dentistry next post!

A little bit of chatting...

2006-02-06T23:28:00.000-05:00

So at six pm a mom comes in w/ 9 yo daughter; she has a cavity, and we're going out of town.... can you fix it? sure; that was an easy fifteen min. procedure, since we didn't have to anesthetize, and the girl was very cooperative.

Mom had a few questions. Actually, she then had an HOUR worth of questions. Since she was the last patient, and I had no where to be, I was happy to answer - why are silver vs. white fillings sometimes better or worse? What about this crown I had done? why do some dentists try to fill everything and others are "wait and see" and now all my kids have cavities??

So I answered her questions for the better part of the hour ans she was ASTOUNDED that I would take the time. Well, if I had someone else waiting for a filling or something, sure, i couldn't do that. But she was SO happy. She's coming back and bringing her husband and other three kids... I figure I could open up a practice two hours away and she'd happily visit twice a week, now that she's sold on the fact that I will always answer her questions when she (gasp) wants to actually TALK to the dentist.

Kinda always ticks me off when people pay 30-70 bucks for an exam and then just get a 50 second "look-see" and no conversation/explanation from the dentist... Yes, sure, it's busy, and you have to whip through folks to make ends meet and pay the staff, but honestly, most folks only need a couple minutes.... so that was gratifying.

In a completely unrelated story, I saw Brokeback Mountain this weekend. Wow; I could just about write a book on the comments heard whilst exitting the theater. wow. more later perhaps....

Am I back? perhaps...

2006-02-05T10:47:00.000-05:00

Due to popular demand (thank you for nagging Sean, Hank, et al.) I have returned to attempt to be a good blogger again. Geez, it's like working out; you really have to be committed!

So, to update, I have 80% sold out; that's right, I'm now working at a private office in Exeter. Everyone says, Oh, NOW you're making the big money! Well, um. no. not yet. Nevertheless, I remain confident that the "big money" will soon come rolling down the pike, yessir.

I'm still one day a week (and more occaisionally) at the non-profit, so I'm keepin' it real for all da homies, yo.

(to wit: "keepin' it real" means "making dentures" and "da homies" equals toothless or mostly toothless folks w/o insurance.

"Yo" is just added for street cred.)

so i'm going to send this off, eat some breakfast and tell y'all i'm back. more to come, perhaps (ooh!) during the Super Bowl.

Nothing is Happening!

2005-09-23T10:17:00.000-04:00

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....

The only thing more fun than a dentist....

2005-09-13T22:28:00.000-04:00

...is 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. :)

Kids are...Fun.

2005-09-08T21:55:00.000-04:00

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 south....it'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 hole...in 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....

Thoughts?

It's Darts Season!

2005-09-02T18:03:00.000-04:00

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.....

How to Extract Teeth

2005-08-31T13:32:00.000-04:00

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 p....er, 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!

Some mornings it just isnt' worth...

2005-08-30T18:33:00.000-04:00

...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.

The Highest Praise....

2005-08-29T17:42:00.000-04:00

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!

Almost Famous

2005-08-28T14:51:00.000-04:00

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

2005-08-28T03:56:00.000-04:00

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 a...um, 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.

2005-08-28T00:06:00.000-04:00

A day at work.....

2005-08-27T23:46:00.000-04:00

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 off....at 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."

"oh."

"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?"

"er...in 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!

dentist blog

Ah, moving day!

2005-08-27T17:38:00.001-04:00

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:

notgartner.com

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!