You Got ME!

This 58-year-old male recently came into my practice for a restorative evaluation. He has a history of nocturnal bruxism and also has evidence of some erosive process that is affecting the facial surfaces of his teeth.

If you note where the lesions are present, mostly on the facial surfaces and more cervical, that would indicate an extrinsic acid source. There is no palatal erosive pattern that would indicate either GERD or an eating disorder. He denies fruit mulling, fruit sucking, soda swishing, or any other common cause of erosion.

I am out of ideas for the causes of his erosion; in addition I’d love to know what you all think about the very prominent texture of his maxillary anteriors. Is it related to his erosion?

I need your help here, I really don’t know what is happening, and all ideas are welcome!



FacebookTwitterLinkedInDiggShare

DRAWING THE LINE ON DENTAL INSURANCE


It’s easy to lose sight of now, but the introduction of widespread dental insurance around 40 years ago was a great turning point for dentistry. By covering patients for at least a sizeable portion of routine dental care, it got people into dental chairs who hadn’t been there in years, it promoted the importance of prevention, and it gave rise to thriving hygiene departments. Insurance represented a huge value to the patient (a $1,000 coverage limit was pretty generous back when the most expensive crowns were about $90), and it was a huge benefit to dentistry because it legitimized the idea of regular dental care.

But the insurance breakthrough did something else too. First of all, insurance providers also introduced a lot of limits: limits on fees, on payouts, on types of treatment, on which dentists patients could see, just to mention a few. Most importantly, perhaps, they eventually created an artificial (but real) barrier in the minds of many patients – a line they draw between two kinds of dentistry. Below the line is dentistry that is covered (and therefore “necessary” in their minds); above it is dentistry that is not covered (and therefore “optional’ in their minds). This is the dentistry that has to compete with TVs, iPads and vacations for discretionary dollars.

But of course the fact is that dental insurance isn’t really like any other insurance we have come to know. When you buy insurance for your home or your car, or life insurance or that matter, the process is the same: you shop around and select a provider, they perform an assessment to determine your needs and their level of risk, and set your premiums accordingly. What’s your driving record like? Is your home in a high-risk flood zone? Are you a smoker?

But for dental insurance, there is no exam performed and no evaluation of needs versus risks. The insurer (who is usually chosen for you by your employer) draws a line of coverage for everyone in the “plan.” That’s the line that many people have in their minds when they think of dental care. And it has nothing to do with their individual dental care needs.

Dentistry has spent decades supporting patients on their dental insurance coverage because, after all, it’s still an important benefit for patients who have it and they have every right to want to use it to its full potential. But the system has also trained patients to develop what I call the “ATC mindset” of dental care: “Anything That’s Covered.” Many, if not most, patients think in terms of what is paid for, rather than what is needed to achieve ideal oral health.

That’s a big mindset barrier to overcome. And it becomes even more difficult when you fall into similar mindset traps yourself – which is what I am going to address in my next post.

How big a factor is the “insurance mindset” in your practice?

View Results

Loading ... Loading ...
FacebookTwitterLinkedInDiggShare

THE 2ND PIECE TO THE PUZZLE IN SHADE-TAKING: THE OBJECT


Let’s talk about the second piece of the shade-taking puzzle: The object.

Teeth interact differently with light than many other objects in nature. Teeth fluoresce. This means that they will emit visible light when exposed to ultraviolet light. To make it simpler, the light shining on the tooth versus the reflected light is a different wavelength.

Why is this important? Because light is changed BY the tooth.

Let’s take an example of another optical property that is influenced by the tooth: Gloss. A porcelain crown in its bisque bake stage versus glazed and polished looks different. Is it different? The answer is no. We changed the tooth’s gloss or the smoothness of the surface.

These are two examples of how the object can influence our perception of the shade. What is the take-home message? If light is changed by the object and if different objects reflect light differently, then the restorative material you choose (and its underlying substructure when required) matters! Depending on the clinical situation (reduction of the prepared tooth, position in the arch underlying tooth color, etc.) your laboratory may recommend one type of restorative material over another.

Picking the final desired shade is an important step, but understanding that other factors influence our perception of color is also critical to the decision-making process of shade and material selection.

FacebookTwitterLinkedInDiggShare

YOU HAVE TO BELIEVE IT TO SEE IT, PART 2

Remember that blog post from my partner, Dr. Glen Wysel, about his trip with his wife, Lisa, to Guatemala to visit the site of the clinic we’re helping to build there? Many of you were quite moved by his recounting of his meeting with the mayor and other community leaders, and by the drawings the children of the area were creating to show their vision of what the clinic would look like.

Wait until you see this:

When Glen and Lisa were there only a few weeks ago, they were looking at a bare patch of land. I could hardly believe my eyes when photos like these arrived in my inbox several days ago – pictures of how the whole community came together and accomplished so much over the course of one weekend. In fact, in just about six weeks they have been able to take this project from vision to reality.

Workers laid the foundation and then more than 100 volunteers from the community came to help raise the walls of their new facility…

And before long they were unpacking equipment and setting up…



I look at these pictures and my heart soars. This is a perfect illustration of what I meant in my last post about the power of belief, and how you have to believe it before you see it.

Take a look again at that child’s drawing:

…and compare it with the reality we see in the pictures above.

That’s the power of belief.

I have to thank all the people – the people in Peronia, the industry leaders who are donating equipment, the people like Patterson L.A. Branch Manager, Jason Owens, who sent a small team to help with the installation of equipment, the dentists who are donating their time and money – for believing with us. If you want to find out more about exactly what we’re doing, go here.

We welcome you to join us.

Update: This post was written just before I left for Guatemala last weekend to attend the opening of the clinic. The events of that weekend have had a profound effect on me and I can’t wait to tell you all about it in an upcoming post.

FacebookTwitterLinkedInDiggShare

The first piece to the puzzle in shade taking: The Light

In my last blog we discussed the four pieces to the shade-taking puzzle. Let’s take the first piece: The light. There are two aspects to this variable that we need to keep in mind: light quality and light quantity.

Light quality relates to the degrees Kelvin (K) or color temperature. You want to look for light sources that are closest to 5,500K, which is ideal for dental shade matching. Illuminants with the nomenclature of D50 fulfill this requirement. So-called “daylight” bulbs are available which can have range up to 6,500K. Color-corrected lighting is available from dental product distributors and home improvement stores. Any source for the bulbs is acceptable as long as it has the D50 designation.

Light quantity relates to the intensity of light, and can be measured by a light meter. The range of acceptability that you should strive for in the operatory is 150 – 200 foot-candles. The amount of light can be of concern in one of two situations: One is where the patient chair is situated directly in front of a window, and the other is in an operatory that has no natural daylight source.

Having the correct quantity and quality of light is a great starting point for accuracy in shade selection.

FacebookTwitterLinkedInDiggShare

A GOOD DAY

Anytime I get all the preps in my impression, I’m ecstatic – even more so when it’s this many preps. Alas, I must confess that the distal margin on tooth #2 had a little fold in it, so I had to do another impression. These are all crowns preps, replacing posterior longstanding crowns, and treating severe anterior wear.

I followed the protocol I’ve learned from Spear for many years, prep to the free gingival margin, place first cord (#00 in this case), position margins as necessary and finish, place second cord (#1 in this case), let sit a bit, take the impression. I’ve followed that protocol for many years and it’s still a banner day when I can get them all, or even almost all. Hope all of your impressions today are perfect … or so close that the second one is just comfortable.

FacebookTwitterLinkedInDiggShare

A Special 2012 Message from Imtiaz

I have been pondering for some time the right message I wanted to communicate as we enter the new year. After all, 2011 was a challenging year for a lot of us, and I think it’s important that we have the right context and the right focus to rally around as we get into 2012. I hope the following gets you inspired – that it provokes your thinking and animates your actions. Please take the five minutes or so it will take to read. It could make the difference in how you choose to approach your future.

You Have to Believe It to See It

It probably won’t come as much of a surprise to those who know me to find out that I was a rather lively child. Some would say too lively. I could be strong-willed and determined. I was always looking for adventure, and often finding trouble. I would forget to take my books to school, or to bring homework home. But I would always find time to climb trees. I would take daring walks on high ledges, or jump off a ferry to go for a swim. I loved to challenge myself, even when it may not have been the “right” thing to do. Especially if it was not the right thing to do.

We had a lot of family and friends around when I was growing up and they often tried to warn my mother about my behavior. They would shake their heads and say something like, “That kid is headed for big trouble later in life – if he survives.” But mother was never concerned. “Don’t you worry about him,” she would say. “He’s going to do great.”

And she meant it. The love and support I got from my mother was immense and unconditional. She was firm when she needed to be (there were lines I knew I couldn’t cross with her), but she always nurtured my passions and encouraged my natural desire to push my limits. She made it clear to others – and to me – how wholeheartedly she believed in me. And that has made all the difference in how I came to see myself and the world around me.

Guess Who?

If it wasn’t for my mother’s love and support during those formative years, who knows how things would have turned out. Maybe my tendency for risk-taking would have taken a bad turn. What I can say for sure is that her belief in me gave me something very powerful, something that has been vitally important to me throughout my life: an unshakeable belief in myself and in what I could accomplish. I can’t point to any one particular moment when I realized this; I just knew that I would make it. After all, my mother was sure of it.

Belief is transferable
What I have learned from this is that belief is a gift you can bestow and the rewards are ongoing. My mother’s belief in me made me believe in myself. That belief in myself has, in turn, led me to believe with passionate commitment in the people around me, and in the things we can accomplish. Belief is transferable and it is a powerful engine for growth. It allows you to take bold measures with confidence. It makes you want to take on life, head-on.

Take, for example, the Center here in Scottsdale. I had no idea when we started the project that it would look like it does today. I couldn’t foresee the partnership with Frank Spear. I didn’t know my sons would come aboard after completing their educations to become an integral part of the leadership team. I didn’t even know what we were going teach. But I did know that dentistry needed a place like this, and I knew that we could be the ones to build it. That conviction came from a very pure place. The Center was real to me long before the first shovel hit the dirt. It was real because I believed.

Great dentistry makes for a great life
Last year, we at Spear brought in a team to help us further define who we are and where we’re going. We had several inspiring envisioning sessions and we finally emerged with a powerful clarity as to what we are all about. We identified our core theme as “Great Dentistry,” and here’s how we define it: “The pursuit of clinical excellence that transforms the practices of doctors and the lives of patients.” A simple sentence to describe a very profound concept.

We also profiled the kind of person we’re committed to helping, who we call The Striving Dentist. The striving dentist is “an individual whose pursuit of mastery in the science and art of dentistry is matched only by the unrelenting desire to succeed in all areas of life.”

That last part is important. What we are doing here, and what you are doing in the practice, can’t just be about clinical dentistry. It’s about taking clinical excellence and supporting it with value excellence and practice excellence. Provide the best care possible at the level the patient is at today, inspire them with your belief in them, and be ready to deliver ideal care when they are ready for it. That’s what makes for a great life in dentistry – and that’s what drives a great life overall.

That’s what we believe, and we want to transfer that belief to as many striving dentists as possible. And we’re doing it. Through our Faculty Club, our Study Clubs, our online campus, and with every course, seminar and workshop we offer, we’re sharing the power of belief.

Let’s believe in each other
This is what we want every dentist who comes into our orbit to feel – the wonderful, liberating feeling of self-assurance and possibility that comes from truly believing in yourself. It’s a feeling of trusting yourself that you can influence patients toward those higher levels of care, and trusting yourself to be ready to deliver that care when they’re ready. It’s about taking a foundation of good dentistry – the everyday care that sustains every practice – and using it to build a framework for great dentistry. It’s about living life with assurance and purpose.

That’s a great way to practice dentistry, and a great way to live. And as I learned all those years ago from my mother, if you’re going to take on the world with confidence, it really helps to surround yourself with people who “get it.” It’s amazing the energy you can get from people who share your belief in what you’re doing.

So let’s make 2012 the breakthrough year for all of us. Let’s do great things together.

I believe we can do it. Do you?

FacebookTwitterLinkedInDiggShare

DIGITAL DENTURES

I had an interesting visit to a company here in Scottsdale that is fabricating “digital” dentures.

The technique is based on impressions that are stitched to an interarch measurement and positioning device that lets the clinician set the position of the maxillary incisors, the vertical dimension of occlusion, and the centric relation position as determined by a single-point stylus that creates a gothic arch tracing. After records are gathered, the impressions are scanned, the interarch record device is scanned, and the two are stitched to produce a virtual mounting.

The technicians now take sets of virtual teeth and “set” the denture just as you or I would at the lab bench. Rotations, curves of Spee and Wilson, and any customization desired can be completed just as if you were working with real denture teeth and wax. Once completed, the denture bases are now milled out of a “puck” of Lucitone 99 that has been processed under intense pressure.

Check out the detail on the milled lower prior to its removal from the puck.

Notice the detailed positions created for the denture teeth. They are now cemented into the prepped areas and the denture is polished and delivered.

A single records visit, one seating visit, and adjustments as required. The company claims fewer of those are required, since the middle steps and the processing reduce the errors inherent in the “old” way of fabricating a denture.

I’m additionally intrigued by the possibility of using this within Earl Pounds’ branching technique, creating the preliminary denture for the functional impression by milling a denture base that is 1.5 mm off the tissue, milling a tissue model, then lining the denture base with Hydrocast and beginning the functional impression process. Since the denture for creating the functional impression was made using the interarch positioning device developed by AvaDent, I believe there would be fewer occlusal adjustments required in the functional impression process.

I’ll keep you posted on what I learn.

FacebookTwitterLinkedInDiggShare