Monthly Archives: March 2010

No, Bite on your BACK Teeth – Part Four

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Teeth Bite Images

OK, I have learned a bunch about mandibular repositioning appliances since I showed this image the first time. I didn’t know what I didn’t know!! When, that happens, I do two things. Ask someone who does and go to pubmed.gov.

I called Keith Thornton in Dallas. Keith developed the TAP appliance many years ago and his practice is now limited to sleep dentistry. I asked him what he thought was going on. He provided me with a long bibliography and then I spent time on pubmed rooting out other info.

It is well documented in the literature, (Franson, 2004, Almeida, 2006 and Ghazal 2008) that mandibular repositioning appliances for sleep apnea and snoring have dental sequelae.  Chen in 2008 reported these side effects: mandibular arch width increased more than maxillary arch width, crowding decreased in both arches, the curve of Spee became flat in the premolar area, the mandibular canine to second molar segment moved forward in relation to the maxillary arch, the bite opened and the overjet decreased except in some molar areas.

Net result is that the bite changes and there appear to be skeletal changes as well.

Anecdotally, Keith told me of a patient he followed for 10 years who developed a bilateral posterior open bite and protruded mandible. Upon death, they discovered he had left his body to science and a colleague of Keith’s was able to dissect the head. He reported normal joints on both sides, not the change in retrodiskal tissue one might expect.

Keith and the surgeon postulate that permanent changes occur in the fossa and the head of the condyle.

What does this mean to us as dentists? First, we are not qualified by training to treat sleep apnea and all of its complications. If we choose to do so, then we need to partner with a sleep physician for the long-term benefit of our patients.  Second, when we do these kinds of appliances we need to be sure that our patients understand the risks and complications. That said, when the ramifications of true sleep apnea are understood by the patient, then it really is a no-brainer…chances of death compared to dental issues are pretty clear to most people.

Next…so, now what do I do with it now?

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Spring on Whidbey Island

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We just completed a busy week in Scottsdale with a three-day Worn Dentition advanced workshop followed by two-and-a-half-day Mastery Level Treatment Planning seminar for the Spear Faculty Club. I shared the case of the single fractured central incisor with the Faculty Club to demonstrate the thought processes of treatment planning, and will continue that case here with all of you next week.

Flying home to Whidbey Island on Saturday night I was looking forward to a restful Sunday off.  I spent most of the day on Sunday around our home and the town of Langley eight miles away shooting photographs.  I love this time of year as everything comes alive again.  Here on Whidbey we are in the transition stage with daffodils in bloom, tulips just starting to open, and trees somewhere in between.  All the photos posted are from the past 24 hours and will give you some idea of what life and nature are like in this part of the world right now.  I hope you enjoy this short photo album.

If you cannot see this video, please visit speareducation.com/blog.

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Are You Penny-Wise but Time-Foolish?

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Appointment BookIt’s often been said that youth is wasted on the young. But I think a lot of people feel that way about time, too. Looking back, we can remember when we had a lot more time on our hands, but not a lot of resources to make the most of it. Now that we’re established, it seems that each day is less about what we want to do and more about what we have to do. Part of that is just a natural consequence of being an adult and having obligations to our families and our businesses. But still—shouldn’t stronger economics create better, more abundant choices for how we spend our time?

A lot of the problem, I think, arises when we are penny-wise and time-foolish. We accept that time in our work lives needs to be carefully structured to give us the best return, but then we try to shove all our other responsibilities into whatever is left and, inevitably, the things we like least get pushed farther and farther down a growing list of must-do’s. But the fact is, if you say you’re going to do something “when time permits,” you’re admitting that your time controls you instead of the other way around.

The answer then is to take back control and schedule the must-do’s of life the way you schedule your work. Often, when I suggest this to someone, I get the objection: “But I don’t want my life to be so programmed. I want to have more freedom.” And therein lies what I call the scheduling paradox—the counter-intuitive fact that the more you schedule your life, the freer you become.

Think of it: what would it be worth to you to begin your workday feeling peaceful, centered, and positive, knowing that everything else is either done or is scheduled to be done? Time for everything and everything in its time. No pressures, no nagging “I really have to find time for that” thoughts to cloud your focus. Try it. Create a comprehensive schedule that fully acknowledges the depth of your responsibilities and fully respects the value of your time. I think you’ll be surprised at how liberating it is to know that at any given moment, you can free your mind to devote the full measure of your attention to the task in front of you.

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Breaking the Curse of Natural Talent

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Hurt LockerI’ve always been a movie buff, not just because of the entertainment and escape they provide, but for the insights you can get into life and human nature. I was reminded of that when The Hurt Locker picked up the top prize at the Oscars.

If you haven’t seen it, the story revolves around a young bomb disposal expert who has the steady hands and steely nerves that make him a natural at his job. But his cockiness and his love for the adrenaline rush of life on the edge often cause him to put himself—and others—at unnecessary risk. The central tension in the movie arises from the question of whether this naturally-gifted, but not always disciplined, young man can come through when the stakes are highest.

I think we’ve all known people like this—the student who breezes through high school but struggles in university, where suddenly everyone is above average. The successful university student who flounders in the real world where there is less structure and more emphasis on self-determination. The natural athlete who is used to dominating games and then finds himself in the pros, getting outhustled by players with less talent but more discipline. For many of these people, early success through natural ability was a curse more than a blessing.

The thing is, many of us have tendencies like this, in some areas and to some degree. We all have things we’re good at, and we tend not to push ourselves in those areas. Maybe you’re a natural at case presentations; you have a gift for communicating in a compelling way, so you don’t feel the need for in-depth preparation. But what if you took that gift and really worked on it, the way you work on the things you know you’re not as good at? That’s where you can make the biggest, most dramatic strides. That’s what going from good to great means. It means looking at the things that are going well—the things you never have to think about—and thinking about how to make them even better.

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Segmental Appliances

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In this video, Gary addresses appliances, conditions and results.

If you cannot see this video, please visit speareducation.com/blog.

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Margin Design

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In this video, Lee discusses the elements of successful all porcelain posterior restorations, including design options, armamentarium, and techniques.

If you cannot see this video, please visit speareducation.com/blog.

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What Do I Do With This? Tyler Part Three

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In Tyler video number three, Frank reveals pertinent patient information that critically impacts treatment options.

If you cannot see this video, please visit speareducation.com/blog.

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Spring Forward

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Baseball Team Running on Field

The first signs of spring are here. Clocks have sprung forward, people are getting outside more, moods are brightening in anticipation of warmer days and longer evenings. And of course, America’s pastime returns to the fields in the form of spring training.

I like what spring training represents. Major league ball players are the best in the world at what they do. They’ve been playing the game all their lives and have developed their skills to the point where they have reached the highest level of their profession. And still, every year, in the season of re-birth, these elite performers gather to shake off the rust of the off-season and work on refining and further enhancing those skills before taking to the field for real competition. This is when they devote serious time and effort to staying on top of their game.

The great thing about being a dentist is that you don’t have to wait for a particular time of year to sharpen your professional skills or take a spring-cleaning-like good look at the way your practice operates. In that sense, springtime is a state of mind, and there’s no reason you can’t bring the spirit of this naturally optimistic season to your work and your life all year round.

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The Color of Money

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20 dollar bills

In honor of St. Patrick’s Day, let’s take a moment to salute the kind of green that plays a big part in making our world go around: money. I know a lot of dentists are reluctant to talk about this—they don’t want to be seen as mercenary, and would rather focus on patient care than bottom line concerns. But it’s a simple fact that the most successful dentists, clinically, tend to be the ones who recognize that ideal practice margins are just as important as ideal clinical margins when it comes to producing ideal results.

How important is profitability to clinical success? Let us count the ways. Economic excellence allows you to:

  • optimize your practice schedule so you have adequate time to do comprehensive treatment planning and deliver the best options possible
  • invest in your environment so you always have the best resources, the best workflow, the best staff optimization, and the best value creation tools to give you the best clinical advantage
  • invest in the best technology—the lasers, CERECs, and digital radiography systems that are setting today’s standard for clinical excellence
  • cover the ongoing costs of replacement and upgrades that comes with embracing rapidly-changing technology
  • take the right time away from the practice to upgrade your—and your team’s— skills, and drive new energy into the way you serve your patients

To me, this respect for profitability as a means of driving clinical possibilities defines the very heart of a true practice of excellence—a thriving environment where doctor and team are always growing, and always committed to the highest standards in both patient care and economic strength. These are the practices that leave others green with envy.

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No, Bite on Your BACK Teeth – Part Three

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OK, it is now official. I didn’t know what I was talking about when I wrote about the complications of the snore guard (see Parts One and Two of this blog series). I was researching a more in-depth answer to the discussion and called Dr. Keith Thornton, one of the world’s leading experts in sleep dentistry and sleep related disorders. After a lengthy conversation I was amazed at how much there is to learn about this topic and both the benefits and complications of different therapeutic modalities.

It is so interesting that I am going to research further and do a series of blogs to try to help us all learn more about sleep dentistry. I will pick Keith’s brain as well as others I know to try to make this meaningful. I am going to ask for a few weeks to put it all together and I promise, we’ll all learn something.

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