Monthly Archives: June 2010

Third Molars: In or Out?

Posted on by
9

Wisdom Teeth X-ray

I grew up in a time when everyone got their tonsils out – well, almost everybody because I never did. I remember feeling that in keeping my tonsils, I had actually missed something – especially all of the ice cream, ginger ale, and attention. When my own children were growing up we practically had to threaten our physician to have our son’s tonsils removed – it was like he was going to have to pay for it if we went to the ENT and they actually did the surgery. Maybe he did have to – I never read much of the fine print in our medical insurance plans.

What I learned was that it was not right to always remove them, and it was not right to never remove them. I’m really not certain where the pendulum is now about tonsils as there are only one set left in my family and I’m hangin’ on to ‘em. I’m a little closer to the question about WISDOM TEETH.

In Pemberville, I scheduled one Friday per month for third molar surgery and it was one of my favorite days. A cocktail of Demerol, Seconal, and Promethazine and those happy patients would let me do anything I wanted. That feeling was rekindled recently (except for the doing anything I wanted part) when I had a request from a colleague to perform third molar removal surgery for a friend. I borrowed appropriate equipment from one of the Faculty Club members, Doug Benting (thanks, Doug!), and removed four teeth on each of two patients. Once the word was out that I had an elevator, a pair of forceps, some 3-0 suture and the willingness to use them, they practically lined up at the door! I really enjoyed the procedure and both patients are doing very well.

This experience brought me back to thinking about thirds and wondering what the current pendulum position is – SO I’M ASKING ALL OF YOU:

Do you routinely recommend removal of third molars?
Why or Why not?

I already put some time in on PubMed to investigate the current thoughts but I really believe the best source will be all of you. I can’t wait to hear what you think.

FacebookTwitterLinkedInDiggShare

Choices

Posted on by
1

From his home on Whidbey Island, Frank tells a story about about how his choices around home and practice have changed throughout his career.

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

FacebookTwitterLinkedInDiggShare

Anchors Aweigh

Posted on by
1

Man Pulling Anchor

In a recent entry, I touched on the importance of having a clear vision to help you close the gap between your present reality and your ideal. But what happens when that vision starts to depress you rather than inspire you? What if the gap you notice the most is the gap between the quality of care you want to deliver and the quality of care most patients routinely accept?

Most dentists I know are fighting the good fight—they’re determined to be the best clinicians they can be, they work hard on aligning their teams and educating their patients—but many of them feel held back from real sustained improvement. Some days are good, some not so good (they can usually tell in advance which it’s going to be from a glance at the appointment book), they make incremental progress here and there, but they seem to be endlessly cycling through the middle ground rather than breaking through. They sense the possibilities of a higher level, but it’s like their reality has them anchored to a lower level.

The only way out of this cycle is to be unconditional and strategic about pushing past the limitations that are holding you back. Your schedule, for instance. If you’re still slotting cases the same way—first-come first-served, 90% routine work—it’s not surprising if your developing skills aren’t translating into better results. You need to reserve room in the schedule every week for the kind of dentistry that reflects your true abilities and the patient’s best possibilities. And yes, just reserving that space does tend to make it happen—not by itself and not every time maybe, but just having that pure intent forces you to strategize in a very focused way. You’ll find that successfully programming in those rewarding cases on a regular basis creates its own momentum.

That’s just one example of how long-term change begins with a change in your everyday thinking, and how pure intent can create amazing results. The bottom line is that sustained success is available to just about anyone who has the commitment and level of engagement required to pull up that anchor once and for all. That’s when you start to feel the full force of the wind in your sails. That’s when your vision stops being a fantasy, and becomes a driving, motivating force that excites you.

FacebookTwitterLinkedInDiggShare

Making the Connection

Posted on by
1

Connection“If HP knew what HP knows, we would be three times as profitable.” That’s what Lew Platt, the late CEO of Hewlett Packard famously said. He meant that he wished he could pool the knowledge of everyone in the organization and make that sum of knowledge accessible to each of them.

Dentists, in particular, because of the nature of their work, don’t often get to exchange problems and ideas freely with colleagues once they leave dental school. That’s why getting out to educational workshops, especially mentor-supported live patient events can be so fulfilling. For that matter, I’m always amazed at how—even if you get three dentists together in an elevator—the questions, ideas and advice start bouncing between brains. I think it’s because you work one-on-one with patients every day and often feel starved for collegial feedback.

Of course, a big factor in overcoming dentists’ natural isolation is this medium you’re using right now. The Internet has created huge possibilities for outreach to the greater community (I’ll have more specifically about social networking strategies in an upcoming post), as well as unprecedented opportunities for quick professional feedback from your colleagues.

For example, right here on the Spear Blog awhile back, Dr. Steve Ratcliff posted a couple of pictures and some data about a particularly challenging case he was dealing with, and basically opened the floor to discussion. It led to some great responses and lively brainstorming. (He’s since posted the solution that has been found to that puzzle, and offered up another case for debate.)

Imagine in the pre-Internet era trying to get a group of colleagues together on the spot for opinions and advice on one of your cases. And think of how fortunate that patient is to have all these leading-edge dentists conferring on her case.

How much do you take advantage of the opportunity to get out to workshops and study groups? How often do you go online to pick the collective brains of dentistry? I invite you to participate in our stimulating workshops, and to spend quality time here on the Spear blogs—not just to hear the voices of our faculty, but to get out of your isolation, join the discussion and be the best you can be by tapping into the knowledge we all have.

FacebookTwitterLinkedInDiggShare

Oh, Shoot! Now What?

Posted on by
22

Okay, gang, need your help on this one. Implant uncovered and provisionalized, comes back a few weeks later and this is what we see.

Now What 03

What do we do? What happened? What would you have done differently?

The implants were placed using a surgical guide fabricated from a diagnostic waxup
There is a temp abutment in the implant and the platform is exposed on the facial. The acrylic that was covering the abutment fractured during removal of the provisional and was left that way for the photograph.

No final solution here; I don’t have post-ops but it will be fun to hear all of your ideas on how to fix this or prevent it in the first place.

Let’s help the doctor figure this one out!

FacebookTwitterLinkedInDiggShare

Attaways

Posted on by
1

A truly inspirational blog from Frank on the value of both giving and receiving positive feedback.

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

FacebookTwitterLinkedInDiggShare

A Riddle About Time

Posted on by
2

ClockI recently had someone come up to me with a riddle, based on my own teachings. ‘Let me understand this,” he said, “you talk a lot about the importance of always giving full attention to the here and now and being in the moment, which makes sense. You also talk about the importance of creating a vision for your future—which also makes sense, but it sounds to me like that’s spending time in the future rather than being fully in the present.” He was wondering how to reconcile these seemingly contradictory ideas.

If you look closer, though, it’s not really a contradiction to focus on your future while being in the moment. I define being in “the now” as giving my full energies and attention to what I’m doing at the moment, whether it’s spending time with my family, or doing nothing, or creating my vision of tomorrow. In fact, I believe that having that full presence of mind is especially essential when it comes to blueprinting your future.

Most of us have a gap between where we are and where we feel we should be. Awareness of this gap is crucial, because the more clarity we have for where we want to be, the easier it is to get there. But too often we spend so much time on the priorities and the noise of today that we don’t think enough about where we should be. If we did, we probably wouldn’t have so much noise around us, because one thing about having clarity for tomorrow: it sharpens your focus about what’s important today.

So the answer, as paradoxical as it sounds, is that one of the best ways of ensuring that you get full value from your time in the present is to spend some time in the future.

FacebookTwitterLinkedInDiggShare

Success Is a Moving Target

Posted on by
Reply

Moving TargetIn my last post, I talked about the metaphorical “junk drawers” in our lives, and how liberating it can feel to once and for all deal with all those things we have put aside for “later.” But there are other reasons, besides just getting the procrastination monkey off your back, for staying current with these claims for your attention.

Any time you delay making a decision, you are in fact making a decision—a decision not to act—and there is often a real cost to that inaction.

Dentists, especially, understand this on an intellectual level. You spend a lot of time, after all, trying to convey this very principle to your patients who are forestalling on needed treatment; putting it off now only means dealing with a more urgent situation later. And that usually means compounding the cost of inaction with the inevitable cost of catching up.

We need to recognize that this same principle applies to our careers, our businesses, and our lives. The world of dentistry, like life itself, is always moving forward, and since all motion is relative, just by standing still you end up losing ground. You don’t have to say yes to every proposition that comes your way, of course. But if the answer is no, say no early and decisively, and move on to the things that are realistic possibilities. Then get those possibilities in motion. Just as a junk drawer creates a life of its own (a life of delayed possibilities), action creates its own rewards.

FacebookTwitterLinkedInDiggShare

You Only Treat What You See – Answer Revealed

Posted on by
5

Here it is, what you’ve all been waiting for – the answer to the perplexing case of our patient with the changing bite.

This is a cut from the patient’s CBCT that shows the complete resorption of the left condyle. Without any available past radiographs it is difficult to know definitively how long her condition has been present.

Mandible

There are no rheumatoid markers or any other arthritic symptoms and her physician has ruled out systemic arthritis.

Her occlusal changes in the past four years were likely caused by an acute phase of the resorption and she has compensated well. The changes she describes are mostly feeling heavier contact on the left side on a periodic basis. Her dentist keeps a close eye on the occlusion and makes adjustments as needed.

The diagnosis here is idiopathic condylar resorption, although the likely cause is a traumatic episode of some sort, perhaps the diving board accident. It is possible that although no condylar fracture was noted or suspected that it could have happened. ICR has also been associated with internal derangements, connective tissue and autoimmune disorders. It eventually burns itself out and a point of stability is reached although it may take several years.

There are some surgeons who advocate an aggressive approach although the surgeon who saw this patient elected to leave it alone since she had no difficulties other than her changing bite. They agreed that if her circumstances changed that they might consider a more aggressive approach. That might include an artificial condyle, orthodontics and orthognathic surgery.

Papadaki ME, Tayebaty F, Kaban LB, Troulis MJ. Condylar resorption. Oral Maxillofac Surg Clin North Am. 2007 May;19(2):223-34, vii.

Wolford LM, Cardenas L. Idiopathic condylar resorption: diagnosis, treatment protocol, and outcomes. Am J Orthod Dentofacial Orthop. 1999 Dec;116(6):667-77.

FacebookTwitterLinkedInDiggShare

Help ‘Em Up

Posted on by
Reply

Frank reflects on a surprising – and very meaningful – moment from the recent 2010 Spear Faculty Club Annual Event.

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

FacebookTwitterLinkedInDiggShare