Living on the Edge

Posted on January 29, 2010 by Steve Ratcliff

I love occlusion. Crazy, huh? I may be one of only a dozen people on the planet who truly enjoys thinking about where the dots and stripes go, but hey, that’s all part of my wonderfulness.

I used to have a collection of distoincisal corners from porcelain restorations in a little plastic lab box in a drawer in my lab. I kept them until I finally knew why they all ended up in that box rather than still being on the patient’s tooth.

Edges01

I had to learn to evaluate how incisal edges relate to embrasure form and to the teeth they rub against. I used to leave that to my lab, thinking that my ceramist certainly knew more about anatomy than I did and that he would take care of those issues for me.

When I seat anterior restorations today, it is only after I completely understand how the provisionals or composite mock-up are functioning, and no matter how skilled my ceramist, I still expect to refine the incisal tables in the mouth. My ceramist can get close, but he doesn’t have the benefit of the patient when he does the restorations.

If I have paid attention to my workup, my mockup and my provisionals, I will have a great handle on any refinements that need to be done. I can check the incisals in all excursions and crossover and probably only need a rubber wheel.

The incisal edge is really a table; a flat rectangular area about 2mm wide that supports the tooth when it is in contact with opposing anteriors. It should be a mirror image of the incisal table it opposes and should have its leading and trailing edges rounded so that they move smoothly against opposing teeth.

Edges02

Starting from a Mindset of Abundance

Posted on January 28, 2010 by Imtiaz Manji

I know we’re all affected by the wrenching scenes of devastation and loss in Haiti. I’m not going to make a plea here for you to donate to the many good causes offering aid—I can honestly say that the people I have come to know in the dental community are among the most genuinely caring people in the world, and I’m sure you have made your own arrangements to help.

I would, however, like to pass along this story of how one enterprising dentist is making a difference by donating the proceeds from the sale of tooth-whitening kits to victim relief in Haiti. Her drive, which she has labeled “Look good, feel good, do good,” has captured the interest of patients, and it serves as a reminder that, as a dentist, you have the opportunity to not only offer aid at a personal level, but to motivate the people around you through creative fund-raisers like this.

This story also brings into focus the whole question of how the impulse to give back is an essential component of real success; I can’t think of anyone I know who has achieved a high level of excellence who isn’t inspired by a sense of abundance and gratitude. And it’s not just a matter of their success creating that abundance—I think these people start out with a mindset of abundance that helps create success. That dentist in this story, for instance: I’m not surprised to read that she has served in an orphanage in Mexico and a Russian public-health clinic. She clearly has a spirit of giving woven into her DNA that drives her to do things like this, irrespective of the level of personal success she has reached.

The act of helping others—whether it’s relief for Haiti, or any number of local or international causes—reminds us that we cannot be truly complete until we give some of ourselves away.

Treatment Planning Paul – Part 5

Posted on January 27, 2010 by Lee Ann Brady

Structural Considerations

Dr. Brady gets specific on tooth structure – are the molars salvagable? How much structure remains? Balancing esthetic and functional concerns for optimal chance of success.

Experience

Posted on January 26, 2010 by Frank Spear

Is faster always better? Taking a break from his fast-paced world, Frank gives thought to slowing down. What experiences do you take the time to enjoy, simply for the experience?

When Does “No” Really Mean “No”?

Posted on January 25, 2010 by Gary DeWood

Fork in the road Gravity is precise in nature, governed by laws and formulas; it does not respond to individual circumstances or objectives. It’s easy because it always works. Clinical dentistry, on the other hand, is science to be sure, but an inexact science at best. Inexact science requires the skill of an artist to create a consistent and predictable result since it is not a matter of an equation, hence the “Art and Science of Dentistry.” This inexactness is why each of us come to a fork in our road daily, and it’s not always easy to know which path to follow.

I had occasion to speak to a Spear participant recently about orthodontics relative to a specific case in which the desired result could not be obtained if ortho was not completed. The patient had said at the evaluation appointment that she didn’t want to do ortho; she’s 60 years old. The dentist completely ruled the ortho option out in her mind, thus choosing which fork in the road to follow.

I am 57 years old and I do not want to get colon cancer. I’ve been told and have read that colonoscopy after age 50 is huge in finding and treating early changes that lead to colon cancer. I don’t want to do a colonoscopy and I don’t want to get colon cancer, so I have a dilemma. My actions have now become inconsistent with my desired outcome. Without blinking an eye or “dealing with my objection,” my physician scheduled my colonoscopy. I don’t want to do it, I won’t enjoy doing it, and I want it to be over as quickly as possible. I am doing it because I must if I meant the thing about not getting colon cancer.

Why do we struggle so much with patients whose actions are inconsistent with what they want from our dental treatment? We need to really listen to people and believe them. A patient who says she doesn’t want to do ortho has not said she would not do ortho. She is saying she doesn’t want to do it, she won’t enjoy doing it, and she will want it to be over as quickly as possible. Too many disappointments (and more than a few lawsuits) have occurred because a dentist compromised treatment and the result was not what the patient expected. Be VERY CLEAR on one thing about compromise – no matter how much you document it, no matter what you have patients sign, the picture in their head has not changed – you cannot win. After it’s all done, and no one is REALLY happy with it, they display it to the entire world, eagerly sharing the name of the dentist who did it.

So which fork in the road do you want to follow?

Spear Study Clubs

Posted on January 22, 2010 by Steve Ratcliff

WOW! We have 66 Spear Study Clubs who are now officially registered and “in the fold.” Hard for me to believe since we just started in June of 2009. With an average club membership of 10 doctors, that is 660 people who are coming to Spear seminars and then committing to learning together for at least a year.

We need specialists to become involved with us and ultimately with YOU! We know that when you and your specialists are on the same page with treatment planning, life is better for everyone – most importantly, the patients!

If you want to know how it works, just go to the top of this web page and click Specialist to learn all about it.

I want you to do this, on many levels. Yes, it is my job and how I earn my living but it is much more than that. I am passionate about small learning groups. I ABSOLUTELY KNOW that if you are engaged in a small group where specialists are involved, and that if you agree to meet regularly, you will become a better dentist.

I also know that if there is a planned program you will learn more, and if there is facilitated discussion, you will learn the most! I believe this with every ounce of my being.

We have what I think is the very best study club solution ever conceived in dentistry. It is integrated and congruent with everything we teach and it gives participants a chance to come to our courses and then have help implementing what they learn here at Spear Education.

Encourage your specialists to do this with you! If I could wave a magic wand I would tap it over every dentist in the country and have them magically appear in a small group of committed learners. It is that powerful.

So POOF, you have been tapped by the wand. Go find a study club – preferably have your specialists start a Spear Study Club – but if not this, then some other club. You owe it to yourself!

Foggy Mirrors

Posted on January 21, 2010 by Gary DeWood

For as long as I’ve been taking clinical photographs of patients, I’ve struggled with fogging mirrors. The solution of course is to warm the mirror to body temperature before putting it into the mouth. For years we accomplished this by rinsing or dipping the mirror in hot water before the shot. Works great. Save yourself a step and a few towels by purchasing a heating pad from the local drug store. As a regular part of your room set-up plug it in, set it on low, place the wrapped mirrors into the folded pad and they will be warm when ready for photographs. Slide them back into the sterilization package between shots and put them back into the warm pad – they’re always ready. You’ll take more pictures – and dentists who take more pictures are always getting better.

Your cats will love it too!

Treatment Planning Paul – Part 4

Posted on January 20, 2010 by Lee Ann Brady

Functional Concerns

A discussion of what to plan for and think about to ensure functionality: exams, wear patterns, patient history, functional occlusion, and equilibration.

Perspective

Posted on January 19, 2010 by Frank Spear

What can we learn from a day at the beach? Using surfing and photography, Frank explains how taking a few steps back can allow for a completely different experience.

Important Enough

Posted on January 18, 2010 by Steve Ratcliff

Time. Time. Time. It always seems to get in the way of “getting it done.” There is always something that pops up that keeps me from finishing that very important project.

That was often the case when I was in full time private practice, particularly when I needed to do treatment plans. They often were delayed until the night before or the morning of the patient’s appointment to review what we’d learned.

That was pretty dumb on my part. The most important service I have to offer my patients is the use of my brain and the knowledge that lies within. Yes, the final outcome is very important, yet if I don’t get it right on the front end then I am scrambling to fix mistakes or end up redoing work that didn’t need to be redone (ask me how I know this).

We owe our patients the very best diagnosis and treatment plan we are capable of creating. Period!

This is one of my staples in my work with my patients today. If finding time to adequately workup a case isn’t important, then the patient isn’t important enough to me and my practice.

I have learned that for me to be effective at this vital responsibility, I must block out time in my schedule to go to our lab in The Experience (with my laptop so I have my images) and close the door so I won’t be interrupted until I am done.

Think about it; you probably instruct your team not to disturb you when you are with a patient, that they are the most important priority in your life at that moment in time. In my mind, the case workup is no different than being with that patient in person.

Are they important enough for you to give them your best?

Monthly Archives: January 2010