Dr. Hills Published Articles

 

      Guest Editorial, Golf, Zen and MMMM, The New York State Dental Journal, 79(6), Nov. 2013, p. 10  
    Most golfers agree there is a special state of mind one reaches when out on a golf course.  Although each player experiences the game in his own way, many enjoy golf because it allows for an escape.  Like a mini vacation, golf provides a break from the stress of life, where the world fades away and only the golf exists.  Usually by the second hole I enter this mindset and for the next four or five hours life is good.  


    I was discussing this with a friend of mine, and she told me how meditation allows her to reach that same place.  Lisa can sit quietly by herself, a few candles burning, some soft music playing and life for her is also good.  Is this the way to the peacefulness many of us are searching for?  Can one escape the stress of a given moment and float above the madness?  If the Zen that is golf can exist at home, on a slow grocery store checkout line, or between difficult crown preps, could not most of the angst we experience daily also disappear through this relatively easy process?

    Eager to see if it would work for me, I purchased some lavender candles, installed “Calm Meditation Radio” on Pandora and, after a quick goggle search of basic technique, settled down to let the soothing tranquility flow through me.  It did not go well at first.  Then again, most would agree it is difficult to master golf the first time on the course.  In golf, one concentrates on one’s swing and on the ball. The object of meditation is to concentrate on nothing, to completely clear one’s mind.  By day three I gave up on the lotus sitting position, found a comfortable chair and, by concentrating on breathing deeply, actually began to feel my heart rate slow and a stillness settle in.  Meditation pundits describe hour long sessions of calm detachment, yet as great as that sounds, in today’s hectic world, I welcome even short three to five minute stress busters.  I have been practicing to calm myself with ultra short meditation sessions and decided it was time to bring My Modified Meditation Moment (MMMM) to the dental office.

    Although I live only ten minutes from the office, the first opportunity to test MMMM presented when two of the seven traffic lights I encounter daily turned yellow.  Rather than speed up to beat the red, I slowed and paused at the yellow signals.  Where is the rush?  Will the two minutes saved be worthwhile?  Why not stop, breathe slowly and calm myself?  Surprisingly, stopping at yellow lights has become one of my new favorite pastimes as I close my eyes, breathe deeply and relax for a moment.  My car is governed at 154 mph, yet these days I get almost as much pleasure sitting calmly at a light as I do contemplating testing the car’s governor.

    All dentists experience pressure and tension in a typical day, it is endemic in the work we do.  When little Johnny, during an alginate impression delivers his lunch into the cuspidor, or Officer Bob keeps his hand a bit too close to his gun during an injection, our stress levels naturally elevate.  When Mrs. Smith refuses to pay a 20 dollar co-pay because she feels it is too much for an exam, x-rays, cleaning and a filling, the stress levels rise again.  Through MMMM, five quiet minutes in my private office and I am ready to face these sympathetic nervous system stimulants head on.  

    So I propose to you the following.  Look into meditation, not the full blown, candles burning, lotus knee bending style that takes great effort.  Instead, try five minutes of calm deep breathing, quieting the mind and see where MMMM can take you.

 

Viewpoint, Robin Williams, Danny Thomas and the Dalai Lama, American Dental Association ADA News, 46(2), January 2015, p. 4

     I have always been a fan of Robin Williams and his death last summer was truly heart wrenching.  I have enjoyed his humor since the days of Mork and Mindy, I fondly remember him surprising my sister and me with an unannounced appearance at a comedy club years ago and certainly the world is a little less happy with his passing.  He spoke in rapid, unrelenting dialogue, but also spoke insightfully.  One thing Robin said was, “Make your life spectacular.”  Isn’t that a remarkable guide to live by?  As dentists, we have ample opportunity to fulfil this lofty goal.

     There are many ways to make one’s life spectacular none more rewarding than the satisfaction of giving to and helping others.  To make a difference in a person’s life, to relieve pain, to help someone feel good about himself, these are things we, as dentists, do every day.  Volunteering throughout the community allows us to give and help others beyond our office doors.  

     The actor Danny Thomas, also admired by his generation, was instrumental in establishing St. Jude’s hospital for children.  St. Jude’s provides palliative, surgical and reconstructive care to children and is famous for the charitable work it does.  To paraphrase Danny Thomas, “there are two types of people, the givers and the takers.  The takers eat better, but the givers sleep better.”  Be a giver, you will sleep better, life will have more meaning and depending on your involvement could even become spectacular.

     Every February I spend a day volunteering at Nassau County Dental Society’s Give Kids a Smile program.  It is a wonderful experience.  Helping introduce dentistry to the children is truly rewarding, lots of fun and not surprisingly, I sleep very well after each Give Kids a Smile celebration.  I sleep well, not because I am tired, but as Danny Thomas so succinctly said, it is good to give. Volunteering is a wonderful thing, donate your time and effort and you will feel better for it.  Make the world a better place and you will be happier.  

     The Dali Lama, one of this planet’s most revered experts on all that is good has said, “Our prime purpose in this life is to help others.”  I have been lobbying my family to spend Thanksgiving this year serving food to the needy.  We can have our own Thanksgiving meal on Friday.  Just think how incredibly well we will all sleep Thursday night.

     The Dali Lama also said, “It is better to want what you have, then have what you want.”  So much in this country is driven by our desire for things.  Materialistic possessions may bring happiness to some, these days I think the Dali Lama may be right, more toys don’t matter, doing good does.  Consider volunteering in your community, the inner peace that comes from helping is certain to follow.

     Look at your children, look at other children, they are the future.  Make the future bright for them.  Be a giver not a taker, you will sleep better and your life may become, as Robin Williams, Danny Thomas and the Dali Lama knew so well, truly spectacular.


      Viewpoint, My Trip to the Dentist, American Dental Association ADA News,  43(6), March 2012, P.4

     I became a better dentist last week.  I did what all our patients do; last week I went to the dentist.  With almost perfect occlusion, minimal restorations, and a truly great hygienist I have needed treatment only twice in the past 25 years.  I had been feeling some sensitivity, figured it was simply recession related and like many patients procrastinated seeking care.  We took radiographs in the office which revealed considerable recurrent decay and a two day adventure began.
 
    My friend Marc, the last dentist to treat me, recently retired and a flood of concerns opened up.  Could the caries be close enough to the pulp to require endo?  Could I need a crown?  Could this actually cost me some money?  I realized these are questions our patients must typically ask themselves all the time.   With the source of the sensitivity discovered and my friend retired, my immediate concern suddenly became who should I call to treat my just diagnosed pathology?   Day one was not going well so far.

      I was upset for ignoring my symptoms and allowing the decay to grow, but was determined to fix the problem immediately.    I thought to call the local dental society for a recommendation of a good practitioner, and then remembered, “I am the dental society.”   Instead, I phoned a periodontist I respect and asked him who he felt would treat me well.  Ten minutes later I had an appointment for the very next day.  Day one was looking better.  
     
     I was a little apprehensive as my appointment time approached, but was determined to be brave and stoic for my new dentist; emotions that all our patients present with daily.  His office was nice, clean and like my own office not cluttered; so far so good.  I pride myself concerning running on schedule and was most pleased when I was seen promptly.  Certainly all patients appreciate being seen on time as I was that day.  The operatory was well appointed, with an older dental EZ- chair.  I used to have that chair, a very comfortable one, a classic from the early eighties, yet one I discarded many years ago.  Is that a bad sign?  Do our patients perceive such things?  Well, the large flat screen on the wall certainly added a modern touch.   Although I presented with a chief complaint of decay on number 15, his complete exam was exactly what I would have done.  We both came to the same diagnosis which was reassuring, and he had my computer program, which in some strange way added to my general comfort level.  

     I decided not to tell my new best friend that I was editor of this publication, certainly not to mention that I may write about my experience, no need to place any pressure on his steady hands.  After some dentist geography, who knows who and such, it was show time.  I decided to keep my eyes closed throughout the procedure, like the blind man comfortable in his home, I knew all that was occurring and did not need to see the details.  No topical, not so sure there, but the very slow infiltration of the Septocaine went well and I felt nothing from the shot.   I introduced Septocaine into my office about ten years ago, this was the first time I experienced its effects, boy that stuff truly works.   I had forgotten what it feels like to have one’s tooth drilled upon, the high speed with its unique auditory component,  the slow speed with its occipital shaking vibrations, sensations hugely different  than the sound and feel we all know from the other end of the handpiece.    When it was time to rinse out, my filling complete, I thought about all my patients and how they too must feel a sense of relief and calm as each appointment is concluded.  I had forgotten how truly emotional a dental visit is.

      Continuing education is paramount to staying abreast in dentistry and sixty hours of courses every three years is required to maintain a license to practice dentistry in New York State.  I propose receiving one hour of non-hygiene treatment every three years as an additional requirement.  Sitting in the largest chair in the operatory was more constructive than all my recent continuing education and more helpful in relating to and empathizing with the patients I treat each and every day.


 My Friend Al, The New York State Dental Journal, Vol 84 (3), April 2018, p. 56                                                            In 2017, my sincere desire is to be more like my friend Al.  You see, Al is the most positive person I know.  A character flaw I possess, one which I am not proud of, is constantly seeing the glass as half empty.  Al’s glass is not only half full, it is most of the time overflowing.  I have decided to be like Al.   

     This is not the first time I chose to embark on a personality transformation.  As a junior in dental school, after two stressed out years, I walked into technique lab one day and announced, “From now on there will be a new Don.”  I went out of my way to say hello, to wish everyone well and to sincerely try and make others glad to see me.  My conversion was met with significant skepticism but I pressed on and, with the passing weeks, my classmates not only accepted my overtures, some even expressed delight in the new Don.  The highlight coming when the most beautiful girl in the class told me she was sorry for not inviting me to her wedding the previous year; but that was before the new Don.      

       I have decided once again to be overly positive and outgoing.  I want to be more like my good friend.  Occasionally I embarrass my family by engaging a passing stranger just for the sake of saying, “hello.”  The kids cringe when, for instance, I ask a random security guard, “Excuse me, could you do me a favor?” Then, after a brief pause, ask further, “Could you please have a nice day?”  The reaction I get to such an inquiry is not only a pleasant acknowledgment of my well wishes, but often a return of equal good tidings.  My family is mortified but I rejoice in passing endorphin releasing positivity to the world.  

     Studies show a happy, optimistic attitude makes one healthier.  Happy people are simply that, happy.  Negativity stifles inner peace and one’s glass is never overflowing if gloomy pessimism permeates one’s existence.  Be like Al.  Bring the positive to the office each day.  Go out of the way to say hello, genuinely ask how someone is feeling, listen to their answer, enthusiastically take part in the interaction.  Tell your lab they did a great job.  Thank the UPS driver for his hard work, greet the mailman with a kind word.  Smile when you walk into the operatory, go to the waiting room when a new patient arrives, warmly welcome her to the office.  Compliment someone’s new shoes (we all see the shoes when we sit patients back in the chair), ask how the soccer game or AP exam was.

       Most important, be genuine, patients understand insincerity, go ahead and be overly interested and positive, but be sincere.  Good vibes ARE contagious, you will feel better spreading kindness.  Our world today can certainly use more genuine cheerfulness and friend-Al like geniality.  A kind word is never poorly received. 

         The world is not half empty of joy, look around and see the positive, let your cup overflow, rejoice in the sunny and the cloudy days.  Go ahead, I implore you, be like Al.


The Dentist and Tilapia Go to Mars, Bulletin of the Nassau County Dental Society, 18(2), Nov/Dec 2012, p. 5

     On August 6, 2012, two thousand pounds of scientific wizardry successfully landed in the Gale Crater on the planet Mars.   The latest rover will explore Mars, helping us understand the planet’s past and its present.  The knowledge gained by Curiosity will help in the future manned exploration of Mars, an endeavor mankind is certain to take.  With a minimum round trip of close to two years, a dentist should be part of that voyage.   

     I figure the reason a dentist must go to Mars is simple, he may be needed.  Do the math; it’s not difficult to calculate.  When Mars and Earth are at their closest it takes nine months to get to Mars. The voyagers would need to remain on Mars for four months until the two planets again align correctly for a nine month return to Earth.  If twenty astronauts travel, the likelihood of at least one astronaut requiring dental treatment is quite high.  Let us not forget with 20 astronauts traveling 22 months, there are 74 combined six month periods away from home and if the traditional six months between dental examinations is adhered to, clearly a dentist needs to go.

     As a dental student, I had the opportunity to speak with Harrison (Jack) Schmidt, an Apollo 17 astronaut and the second to last man to walk on the moon.  Mr. Schmidt came to Northwestern to speak to the Geology Department and I was not to be denied entrance to his lecture.  I studied up on my anorthositic and basaltic compositions, found a seat in the back of the room and thoroughly enjoyed his slide show of the 17th Apollo mission.  At the conclusion of the discussion, knowing I would never walk on the moon, I found myself compelled to at least shake the hand of someone who did.  Surrounded by geology graduate students, I shook Jack’s hand and confessed I was studying dentistry not pyroclastic eruptions.  He welcomed me into the group and shared some dental trivia with me.  It turns out each Apollo astronaut was given a crash course on how to pull a tooth.  Apparently, in planning for any possible scenario, NASA instructed the astronauts in the most aggressive of dental treatments.

     Since the days of GV Black, dentists have continually advanced our science, regularly developing new techniques and procedures to improve the care we provide to our patients.    On Mars, practicing dentistry will be similar to here on Earth.  Martian gravity allows for traditional treatment, albeit in a fantastically untraditional location.  The exciting new techniques, however, will be developed for treatment during the years of traveling in zero gravity.  Entirely novel methods will be acquired, as even the simplest procedures of irrigating, rinsing and suctioning are impossible in a weightless environment.  Some of the new skills and materials will inevitably improve care here at home.  The “extraction only” treatment by Apollo astronauts is clearly unacceptable as we go forward in space exploration.   

     Now concerning the tilapia, I must admit the title of this editorial is intended to grab the reader’s attention, yet it is entirely possible that a tank full of tilapia will also be part of space travel.  Tilapia is an excellent source of protein, provides a desired variation from freeze-dried NASA food, and with an ability to survive solely on excrement, is the perfect companion to recycle waste and conserve important resources during confined, extended space travel.

     The reality is, although all this sounds like science fiction, we will be going to Mars within the next 30 years, and I have no doubt a dentist will be part of that journey.


Ted Williams’ Head and the Dental Pulp, Bulletin of the Nassau County Dental Society, 17(3), Jan/Feb 2012, p. 5

     In 2002 Ted Williams died.  Williams was one of the greatest baseball players of all time, and although his time was considerably before my time, his heir’s unique desire to cheat time, led them to be the first of their time to think one could live in a future time.   His will stated he wished to be cremated and his ashes spread over the Florida Keys, however, in a celebrated court battle his children waged war with each other concerning his true wishes.  They clashed over cremating or cryogenically freezing their dad.   

     Ted’s son John Henry and daughter Claudia claimed Ted was a man of science and truly believed cryogenics could bring them together at a later date.  His eldest daughter Bobby-Jo Farell thought otherwise and fought for a dignified cremation.  The late night comedians, the main street media and just about everyone else enjoyed a laugh over the Williams family feud.  John Henry and Claudia prevailed, a company named “Alcor” froze Ted Williams, and the truly amusing part of the story surfaced when it was rumored that Ted’s head was damaged during the process.   Would he thaw well?  Would he be the same Ted? What about the head? Clearly the comedians had a field day with the possibilities.  In 2002 cryogenics, in its infancy, was fodder for comedy, in 2012 science has changed all that.  

     This brings me now to the dental pulp.  I recently attended a continuing education course on stem cell research and the science of cryogenics was thrust into my small dental office existence.   Suddenly, as it affects my younger patients, I was presented with my own Ted Williams scenario.  The dental pulp is a good source of stem cells and although embryonic stem cells are still the gold standard, pulpal tissue can be used to harvest human stem cells.  Most importantly, these cells are obtained without the moral implications surrounding the use of embryonic cells, and autogenous stem cells are most desired since they eliminate the need for anti-rejection medications which often complicate tissue or organ transplantation.   Parents are now able to contract with a cryogenic company to harvest and preserve viable stem cells from extracted teeth and offer the possibility of using such cells in the future.  StemSave™ provides an easy to use kit for the transfer of extracted teeth to their facility where stem cells can be harvested and cryogenically preserved.  According to StemSave™, pulpal adult stem cells, ideally collected when the patient and their cells are young, are the best to preserve.  Teeth extracted for orthodontic reasons are no longer truly sacrificed; they may one day aid in a medical advancement to save that individual’s life.   

     I spoke with Dr. Tatyana Michurina, a cellular expert at the Cold Spring Harbor Laboratory in Cold Spring Harbor.  Dr. Michurina reports, “Now is an exceptionally exciting time to be working on stem cell research.”   At present, scientist can obtain blood cells from hematopoietic stem cells, epithelial cells from epithelial stem cells and, as published online in Cell Transplantation (November 5, 2011), pulpal stem cells from extracted teeth have been grafted and shown to aid in the repair of osseous defects (in puppies).  Although embryonic stem cells still show the most promise, as science advances, the possibilities of pulpal stem cell use are truly exciting.  If pulpal stem cells can one day have the variability that embryonic stem cells possess, then science will take an historic leap.  

     John Henry and Claudia Williams may have been ahead (no pun intended) of the curve concerning cryogenics, they certainly overreached in their attempt to preserve a complete individual, yet their belief in the unlimited potential of science is encouraging.   As dentists, it is unlikely we will develop more efficient solar energy, or improve world food supplies, but it is now in our scope of practice to be an active part in the evolving and rapidly changing medical advances in stem cell science.


                    Widget Supplies, Bulletin of the Nassau County Dental Society, 17(5), p. 5

     I was out of town last month, with some time to kill, so I went into the hotel bar for a drink.  In there I met Tony, a true entrepreneur whose success and jovial attitude led to an enlightened conversation concerning the ups and downs of running a small business.  I shared with him some of the pitfalls and triumphs of dentistry and he was most informative concerning the manufacturing of widgets.  As in dentistry, manufacturing widgets requires expertise, precision and a great many parts and supplies.

     Tony has been assembling complex biological widgets for three decades and explained that twenty years ago there were many companies to choose from when ordering supplies for his business.  Back in the 1980’s, one company was known for having the lowest price for all widget supplies.  Acme was a highly successful, growing supply company; the vast widget universe was well aware their prices beat the competition and other supply companies often had to “match Acme’s price.”  Some widget supply companies would offer to “beat Acme prices by ten percent,” Acme was the clear leader and their low prices helped keep widget manufacturing cost down.

      With progress comes change and widget manufacturing methods were dramatically altered by a paradigm shift in Acme’s business model.   In an aggressive move to dominate market share, Acme began acquiring and merging with other widget supply companies.  Through both friendly mergers and aggressive hostile takeovers Acme followed the corporate America, 1990s win at all cost template, to beat down competition.   Naturally, in order to pay for their expansion Acme had to raise their prices.  Widget manufacturers soon received catalogues not once, but twice a year with concurrent price increases, and Tony told me his blood pressure would rise every time a new glossy, five pound catalogue would appear in his mail.  Acme no longer offered the best price, sadly the competition no longer had to match or beat their number, and all supply companies were able to raise their rates as well!  Widget manufacturers no longer benefited from fierce competition in the widget supply industry and were forced to pay significantly more to produce their goods.    

     Acme became the world leader in widget supplies and aggressively promoted their services to all widget producers.   With great power comes great responsibility and Acme developed a dynamic marketing strategy to polish their world wide image, while deflecting concerns their higher prices were adversely affecting  customers.  Acme boldly expanded their marketing by generously donating to and sponsoring many widget manufacturing events.  Tony lamented to me that, although Acme was very generous with its donations, in reality he was paying considerably more for his supplies than he was prior to Acme’s exponential growth.  I argued with Tony that even though his supplies may cost more, Acme’s good will benefits all widget makers.   Tony would not listen to me.  

     Clearly there are two schools of thought concerning the higher cost of widget supplies.  Tony’s concerns were, to a large extent valid, and I had a hard time demonstrating to him how the money Acme was spending promoting widgets is supporting his industry; all Tony saw was increased costs.   I argued that individual widget manufacturers are unable to, or unwilling to, finance large widget events and Acme is providing a needed service, vital to a healthy widget community.   Tony countered, if all the extra money manufacturers are paying for costly supplies is combined, more could be spent sponsoring and promoting widgets.  Unfortunately, small widget manufacturers don’t donate their savings and large companies such as Acme must step up to help widget makers prosper.

      So what is the best solution?  The answer is unclear.  Escalating supply costs adversely affect small widget manufacturers, and containing costs is important, yet so is funding for positive widget image.  My evening discussion with Tony, as spirited as it was, left me with one very obvious conclusion - I am truly happy  I don’t manufacture widgets.

 

                      Door Costs, Nassau County Dental Society Bulletin, 18(2a), 2013, p. 5

       In 1992, I decided it was time for a significant change in my practice.  It was time to do what all dentists of that era were doing.  It was time for a new door.  A new door, I knew, would make the office look high tech, and we would become more efficient and productive. There were lots of door companies to consider and they were all prominently displayed at dental meetings.  After considerable research, I purchased an expensive door for the office.  My door came with one year of free support.

       I loved my new door, it did everything I expected; it opened and closed superbly.  About a year later, strange things started to occur.   One day a large, short cropped hair man with an accent appeared.  He informed me that in order for my door to continue to work I had to pay “a fee.”   The fee was roughly 10% of the cost of the door.  I was relatively new to the door and figured it was a good idea to purchase support from the man.  The next year the man appeared again and insisted on 20% of the cost of the door for his continued support.   He communicated to me that if I did not pay the “fee,” the door may not work correctly.   I never required the man’s support, so I chose not to pay the “fee.”  My door started to act strangely.  At times it would open, yet, could not be used.   Indignant as I was, I paid the man; my door was given a special code and instantly cured of its viral malfunctioning.  
         In 1995 the man appeared again.  In 1995 all the doors were incorporating windows into their design.  “My door is fine,” I protested.  Unyielding the man insisted on 30% of the cost of my original door to install my windows.  Apparently another door manufacturer with a lovely pear on its façade had been operating remarkably well with a window like appearance.   By now, my office was so dependent on the door; I had no choice but to buy the windows.  We had a few smooth years enjoying the ease of my door with its windows.  Then in 1998 the dreaded man appeared again and foretold of dire consequences for my door with the approaching new millennium.   He was not sure, but he suspected that my door would start acting unusually as the year 2000 approached.  For 60% of the cost of the original, the man would adjust and protect my door.  I refused to pay!  On January 2, 1999 my door began to seize up.   I called the man, only to be told of his warning about potential millennium trouble, and for the 60% payment he would be sure to fix my corrupt door.  “The year 2000 is still twelve months away,” I protested.  With unyielding disdain the man insisted on 60%.  March 1st, 1999 the door would not open and I paid the man his money.  

          In 2005 I was told that my door required a “new platform.”   The master door maker decided another platform would aid in door use, and the hair-challenged man insisted on 100% of my original cost to keep my door functioning.  Today, parts of my door are up in a cloud somewhere.  I have no choice but to pay the man, I truly have no idea how to maintain doors that operate in clouds.

          I spoke to my friend Tom who also works with doors.  It seems to me that embedded in the very soul of my door are instructions for it to malfunction if I ever fail to pay the man with the short hairstyle.  Tom told me he too designs his doors with built in pending disaster to encourage customers to support his business.   It doesn’t seem right.  Decades ago when payment was demanded of shop keepers to prevent damage to their business, police got involved and the practice ended.  It seems unjust in today’s door filled world that small businesses like dental offices must continue to pay annually to obtain smooth operation of their indispensable entrances.


             Dentists Should Not Shoot Lions, Nassau County Dental Society Bulletin, 20(4), 2015, p. 3

      The news last summer of a Minnesota dentist killing a beloved lion in Zimbabwe is tragic in a number of ways.  Certainly our planet lost a unique celebrity, a majestic creature of the wild whose tracking device entertained children and adults throughout the world - but, the dental community also suffered a loss.  All publicity is not good publicity.

      Every reference to Cecil the Lion noted he was slaughtered by a dentist and the dentist’s B-1 (or is that shade B-0) smile accompanied many of the early news and social media stories.    It is unfortunate the media insists on linking this tragedy to the killer’s profession.  It is even more unfortunate this story does not go away as I am continuing to see comments and references to the lion killing dentist.  The public expects more from certain professionals and dentists are held to a higher moral ground.  We cannot shoot lions, and especially not world famous lions.

      It is not my intention here to comment on the pros and cons of hunting.  Certainly if one wants to sit in a row boat, in a marsh, in the cold wet dawn hours and shoot ducks, enjoy and have fun.  If you kill a really big duck, let the newspapers announce it to the world.  But kill a rhino or lion, legal or not, looks really bad, probably isn’t a good idea and the terrible publicity will last for a very long time.

     As dentists, we are judged differently.  We need to be aware and act accordingly.  As much as I would like to, my wife does not allow me to go out at night in my comfortable old ripped tee shirt, so I don’t.  Our appearance and image does matter, we are always seen as “the Dentist.”  
Our profession sometimes suffers with an image issue.  In pop culture the dental experience, and the dentist himself, is often seen negatively and the nature of what we do can add to the stereotype.  If we are held to a higher standard and must overcome unflattering references, we need to be especially sensitive to how we behave.  It seems obvious, don’t shoot the lion.  

     Instead do something special, something that screams hey look what the dentist did!  Volunteer at a Mission of Mercy (MOM) or Give Kids a Smile event.  Help those less fortunate, volunteer your time, speak out against something wrong, coach a little league team, sing in the choir, or serve dinner in a soup kitchen.  There are so many ways to make a difference.  Sometimes the less you are noticed, the more satisfying it can be, staying below the radar can bring even greater gratification.  

      Unfortunately as a dentist it is much harder to stay below the radar.  The public expects more from us, our radar is set lower, any misstep we make is magnified and the media seems to rejoice in our folly.  We need to be extra careful, we are held to a higher measure and we should be, it comes with being a complete professional.  So please be careful and if you are considering shooting any lions, be especially sure only megapixels are involved.


                  Hafid and Rebecca, Nassau County Dental Society Bulletin, 21(1), 2016, p. 3

      Part of the application process for dental school these days is a requirement for prospective students to spend “observation time” in a dental office.  I think this is a wonderful addition.

      Charles Dickens would look at our world and again lament, “These are the best of times, and these are the worst of times.”  Global conflicts affect us all, terrorism and refugees from war ravaged regions dominate the news.  The Middle East is torn apart by ideology, politics and religion.  Red states, blue states, liberals, conservatives, the political narrative is truly divisive.  Rodney King, if he was alive, would certainly cry once more, “Why can’t we all get along?”  Helping two young college students obtain their “observation time” in my office during the past year has led me to believe there is hope, maybe we can all get along.

     Rebecca’s dad (not her real name) and I exercise in the same gym.  A physician, he approached me one day and asked if I would consider allowing his daughter to shadow me in my dental practice.  I thought it was a wonderful idea and welcomed Rebecca into my world.  She was most eager to see dentistry from the other side of the dental chair.  She dove right in, couldn’t get enough, she was keen to hold the suction, to see all she could and became an instant help.  Rebecca’s family are Orthodox Jews.

     Hafid’s dad (also not his real name) is a radiology tech who helped me with an image.  His son is also considering dentistry.  When I told him his son would be welcome to observe in my office his thank you was so sincere, his gratitude so genuine, I knew Hafid would be special as well.  Hafid also wanted to see it all.  He came that first day, pen and pad in hand, and started sketching the procedures to help understand what we do.  Hafid was more hesitant than Rebecca, more reserved in his manner, clearly nervous, yet just as eager to learn.  Hafid’s family are devout Muslims.

      My office became a microcosm of global diversity.  Here were two young people, from very different cultural backgrounds, with extraordinarily similar aspirations and desires.  Hafid and Rebecca were so similar, in so many ways, no one noticed the inflection in their voice or the complexion of their skin.  
We never talked religion, we talked dentistry.  Politics were not part of the discourse, dental materials and treatment techniques were.  The only isolation discussed concerned the benefits of a rubber dam.  There was no talk of bloodshed, instead any blood shed was enthusiastically suctioned by Hafid or Rebecca.  Their mutual desire to learn, to see it all, was a pleasure to witness.

     The patients in my practice come from all walks of life; a diverse group of people, they accepted both Rebecca and Hafid equally.  I fear, unfortunately, appearances may influence how patients, and society would view my two young apprentices.  We wear surgical scrubs at work; I enjoy the comfort, cleanliness and easy maintenance of a life in scrubs.  I instructed Hafid and Rebecca to follow my lead, yet I wonder if the atmosphere would be different if they dressed more piously. I truly hope this is not the case.

      Rebecca returned to college upstate, while Hafid remained on Long Island to further his studies.  With significantly better financial backing Rebecca may have an advantage, Hafid’s parents are first generation immigrants, but such differences are part of the American melting pot and Hafid certainly deserves the same opportunity Rebecca enjoys.  I offered Hafid a job on Saturdays and he continues to observe and learn.  I am confident both of them will succeed and should become wonderful dentists

      Rodney King would be proud, maybe we can all get along.


     The Irrational Expense of a Dental Education, Nassau County Dental Society Bulletin, 21(3), 2016, p. 3

      The debt incurred by today’s dental school graduates has profoundly changed our profession.   Student debt is a key determinant influencing how and where new dentists practice resulting in changing delivery of care models throughout the country.  Recent graduates must consider their student loan obligation when making career choices.

      There is something very wrong when a dental school has the resources to market itself on television while students pay close to $100,000 annually in tuition.  Historically, tuition costs have risen faster than inflation and there is little indication these rapid increases will lessen any time soon.  As long as students are willing to borrow to pay the cost, there is little incentive for schools to curtail their increases.  Dental schools, particularly private institutions, are businesses, they exist to educate dentists, but also to generate profits.

       Promissory notes are signed like Monopoly money and recent grads are stifled with 30 year mortgages.  It is not uncommon for a new dentist to have $200,000 to $400,000 in total student loans.  These numbers are absolutely astonishing to me.  Couple this with the broken “portability” (we used to call it reciprocity) of a dental degree, and new dentists face a challenging landscape which questions the recent rankings by US News and World Reports that dentistry and orthodontics are the two best jobs in America.

      Although the single proprietor is still the most common practice setting, staggering student indebtedness has forced many recent graduates to look to the corporate model for the security of a weekly paycheck.  Regardless of how one feels about the corporate design of dental practice, it is important to remember the key word is “corporate,” and corporations exist to realize profits.  Ultimately, patients suffer when the delivery of care transforms to a business paradigm where production numbers take priority concerning treatment choices.  Overtreatment becomes the mantra of the day. 

       A closer examination of dental school revenue reveals a disturbing trend.  The ADA reports by 2014, student tuition and fees made up a larger share of the revenue at U.S dental schools, climbing from one quarter in 2004 to 37.7 percent in 2014 (ADA News, 47(12), 1., June 20, 2016).  This is a truly upsetting figure as it reflects a corresponding decrease in revenue from clinical procedures.  Simply stated, dental students are graduating with significantly less clinical experience.   

     I recently had the opportunity to speak with some senior dental students.  Their dental school produces a large number of new dentists annually and each graduate is crippled with crushing debt.  I asked what the biggest challenge to graduating is, and shocking to me one answer was, “finding a three unit bridge.”  Excuse me?  When I graduated from Northwestern in the 1980’s, clinical requirements included 30 units of crown and bridge and 25 indirect operative procedures.

     Then I thought, oh I get it, they must be restoring dozens of implants before graduating.  Unfortunately, that is not the case as another student told me she had the opportunity to restore only one implant so far.  Equally shocking was learning from the students some clinical requirements could be satisfied on a typodont!

     Instead of continuing down an unsustainable course of rising tuition, high priced dental schools should reduce tuition and increase the requisite procedures for graduation.  Derive revenue from helping better educate students.  All dentists know, the more we do a procedure, the better we become at mastering such.  One three unit bridge and a few full dentures does not adequately prepare anyone for private practice.  If schools have trouble attracting enough patients to allow for a significant increase in clinical requirements, then clearly class sizes are too big.  Supply and demand is a very simple economic concept which some dental schools do not remotely understand.

 

              The Great Floss Debate of 2016, Nassau County Dental Society Bulletin, 22(1), 2017, p.3 
     Last summer the associated press reported there is no proof flossing is beneficial.  This absurdly ill-informed notion is based on the lack of randomized controlled studies proving flossing is good for you.

     The lack of a randomized controlled study proves little.  There are no randomized controlled studies proving parachutes or scuba equipment work, yet I certainly wouldn’t dive to thirty feet without a tank and one would be hard pressed to find  (even among those who jump out of airplanes) someone to plunge from 3,000 feet without a chute.

     I propose to those who feel flossing is not advantageous, stop flossing.  We see such rebel rousers in the office all the time.  Every day my hygienist bemoans, “Why don’t these people brush better?”  Or, “Does he even own a toothbrush?”  Or the more emphatic, “He refuses to floss!”  I truly doubt controlled studies substantiating floss effectiveness would motivate any of our hygiene challenged patients to alter their routine.

     It is possible the great flossing controversy of 2016 was initiated by a hastily tweeted comment from a periodontist.  After all, many accept spontaneous, irrational, ill-conceived tweets as fact, and poor hygiene does play well for the perio folk.  Who needs science?  If the tweet sounds good, so be it.  Peer reviewed scientific journals are never read by voters, I mean patients, and if some seemingly important personality tweets, millions will follow.  So what is it?  The lack of randomized controlled studies, a late night tweet, or is it something even more sinister?

     Is there perhaps a misguided “us versus them” politic concerning flossing?  The flossing camps are aligning themselves with their constituencies and I fear for our collective future.  There has been much speculation concerning undue influence by acrylic suppliers and their well-financed effort to hijack public opinion.

     Many are now saying the Flowplast (not its real name) organization is responsible for disseminating anti-floss stories in the media.  Floss manufactures are losing influence and denture makers are in a new found position of power.  Those who are sensible and floss daily appear to some as arrogant elitists, while the edentulous continue to deny even the existence of requisite subgingival hygiene.

     Rational thinking may still win out.  Facts are facts, lack of randomized controlled studies validates nothing and science is science.  Plaque builds up and needs to be removed, denying such doesn’t prevent it from happening and ignorance is a poor standard for one’s health. 

    Moving forward, I am guardedly optimistic for our collective future.  Misinformation must not become the new bellwether for informed debate.  The oral health of our country, in fact of the entire world, depends on sensible decision making and attempts to mislead the public will certainly do more harm than good.  Denying facts, twisting logic to pigeonhole a misguided agenda must not be allowed to influence oral health understanding.  The very direction of our country’s gingival condition will depend on true bipartisan cooperation, a rational acceptance of science and, as all dentists understand, consummate acknowledgment of the benefits of dental floss.  

 

 

                       I Had to Buy a Suit, Nassau County Dental Society Bulletin, Vol. 23(2), 2018, p.5

         The girls who grew up with my daughter are beginning to marry.  I own a nice tuxedo and, since most of the dress up times in my life call for black tie, it is easy for me to dress up. One wedding this summer was not black tie and I was compelled to wear a suit.  I am not a suit and tie guy.  The last suit I purchased was 11 years ago, styles have changed significantly since then, I look terrible in my old suit and I was told by my wife to throw it out.  After visiting eight different stores, I bought a new suit.

          I change my glasses every few years.  I like to shake it up now and then with a new look.  New glasses are fun but every decade or so, as with the new suit, a more radical change seems right.  So, I changed my beard. 

         Cosmetic dentistry offers our patients a fresh look as well.  Cosmetic dental procedures, like my new suit and beard, make us feel good about ourselves.  Unlike changing fashionable attire or facial hair architecture, dental treatment, with few exceptions, is irreversible.  It is what puts us stratospherically above the tailor and barber.  A patient’s commitment to removal of enamel is a lifetime commitment.  As dentists, we must take great care when our patients request and consent to such treatment.  Cosmetic dentistry is not like buying a new suit.  

         Teeth whitening, after a thorough examination and cleaning, is a safe, reversible procedure.  Hair coloring is also safe, effective and reversible.  A suit purchase, although not reversible, is rarely dangerous.  The public has embraced whitening.   My wife can color her hair, I can spend four days shopping for a suit and whitening products are sold everywhere for personal use.  Buying whitening products is similar to buying a new suit.  At home orthodontics, from a kit purchased in a department store or as seen on TV is something absolutely different.  I simply cannot fathom do it yourself orthodontics.  Moving teeth is not like coloring hair or buying a suit.   

          Practicing dentistry without a dental license is illegal.  Mr. Jones cannot perform a whitening procedure, filling, extraction or orthodontics on Mr. Smith.  Mr. Jones can, however, do whatever he wants to himself.  He can bleach his teeth in any manner he wants, he can pull his own tooth, and now he can purchase ortho aligners online and play dentist for a fraction of the cost of care by a licensed professional.  

          I wonder if Mr. Jones, while placing his just purchased orthodontic aligner, slips on the wet bathroom tile he recently installed and fractures his arm, would he be able to set and cast the fracture himself?  Is there a possible business model for self-administered orthopedics?   For that matter, dermatology seems pretty straight forward. If Mr. Jones doesn’t like that rather ugly mole on his chin, could he not simply cut it out and mail it off to a pathologist (perhaps in a foreign country where labor is cheap and pathologists are waiting for self-administered biopsies) for evaluation.  I imagine these pathologists work real near a call center, where a return call to Mr. Jones can conveniently take place.

          We live in a free society with many inalienable rights, including the right to self-administer one’s healthcare.  Just because you can, doesn’t mean you should and the adage buyer beware certainly seems appropriate here.

           By the way, the contemporary style of a tight, form fitting short European suit does, in fact, work very well for me and for the first time in decades I do like my new suit.


                             My Other Left Arms, Bulletin of the Nassau County Dental Society, 24(1), p. 5          

            The first week in March is Dental Assistant Week.

             When I was a boy my dentist practiced by himself.  His pulley driven electric slow speed dominated the operatory, he triturated and placed amalgam solo and developed x-rays while I rode my bicycle home.  Suctioning was left to the saliva ejector, countless cotton rolls and a busy cuspidor. There were no dental assistants and the scarcity of conversation in the operatory added to the anxious experience.  Like a dental student, old Dr. Liebowitz labored in his world unaided in a two-handed existence.

               It is impossible to practice two handed dentistry today.  Modern dental materials and procedures demand four hands on board.  I wouldn’t want it any other way.  My dental assistant Cassandra (my other left arm) makes me a better dentist.  She thinks as I do, our treatment flows in an unconstrained dance of familiarity in an almost telepathic manner.  At times, a simple glance of the eye is all that is needed, she anticipates and understands the demands of what we do.  

                In my office, I sometimes distract patients from their treatment by having a mostly one sided, over the top conversation with Jeanmarie (my other, other left arm).  Heavy sarcasm and an absurd story line often adds to the banter.  Patients become so focused on the narrative they forget, for the moment, what’s happening in their mouth.  Jeanmarie is the perfect set up man, keeping the conversation flowing and the distraction spirited.  She too makes me a better dentist.

                 The second week in April is National Dental Hygienist Week.

                A truly great Hygienist is a huge asset to any dental practice.  Elsy (no appendage relation) is the genuine real deal.  Patients love her; she too makes me a better dentist.  It takes a very special person to live amongst the Graceys and Barnharts; all dentists should acknowledge and praise those who do.  How Elsy so thoroughly scales the distal lingual aspect of an exposed mesial buccal maxillary molar root is an enigma to me.

                 The second Wednesday in May is Receptionist Day. 

                  Why there is no Dental Receptionist Week and receptionists of all types are praised in just a single day seems rather meager in comparison, none the less, Maria is equally deserving of praise.  She not only handles the front desk, she explores the deep crevices of our software and navigates the insurance world with ease.  Thank you, Maria.    

                   Our staff makes us who we are.  They are more than our left arms, they are our friends and confidants.  They see it all.  They calm and settle patients.  They listen to our stories over and over and never complain.  They hear the same jokes countless times and still patiently wait for the punchline.  We simply cannot do what we do without them.  Absence my staff, my office simply could not function.

                   So please take a moment (or two) and tell your staff how much you appreciate their efforts.  They are the resin that bonds a dental practice into a well-functioning team.  Praise them for a job well done, listen to their stories as well, buy them lunch.  Remember a dental office is a team arena, success is a team effort, excellence only happens when the entire team functions together and none of us can truly provide superior care without the great help of our other left arms. 


               HIPPA and the Pink Stuff, Bulletin of the Nassau County Dental Society, 24(2), p. 6

            I read the New York Times every day on my phone.  For about a week now, I noticed on my app a preponderance of advertisements clearly focused on a very personal issue.

            From time to time, I go to my medicine cabinet for a particular pink medication.  I never see advertisements for this favored pink bottle in the print edition of The Times, yet an ad appeared on my phone version daily.  How, I must ask, does the NY Times know of my preference for intestinal relief?  I simply cannot accept a global advertising campaign by The Times towards pink medicaments, and must acknowledge they had inside information to target an ad concerning my clearly personal bodily function.

            I have never searched online, or discussed while Alexa was listening, any hint of intestinal distress and figure it may have been Costco.  As we all know, Costco scans one’s membership card at the register and knows everything we buy.  A few months ago, I purchased two rather large bottles of said pink medication, Costco figured my supply may be running out and this would be an excellent time to remind me to fill up on my soothing palliation.  Do they perhaps not understand the size of their products, and is it not rather bold of them to figure I would run low so soon?

            I have so many questions here, but perhaps most important, could this be seen as a HIPPA violation?  Do Costco and The NY Times not have HIPPA compliance manuals?  Do they not have annual HIPPA training for all employees?   Please understand, the NY Times and Costco are two of my most favorite companies, I thoroughly enjoy both, they are clear leaders in their field and I, in no way, want to disparage either of them, but targeted advertising, likely demonstrated here, is now part of our national debate. 

             Could dentist benefit from such an approach?  Could we reach out to retailers for the names of those who purchase denture adhesives and target them with advertisements for implants?  Of course, we could.  Would prospective patients question the source of such advertisements as I do the pink stuff ads?  Perhaps they would.  Could a perio office request the names of people who return floss purchases?  Could general dentists obtain the names of those who search online for temporary filling materials and push ads to such sufferers, in real time, offering to see the prospective patient within 12 hours?  Would patients be turned off by three separate dental office solicitations for relief of their lost filling?  I know I would! 

            If, in fact, we agree this is a violation, then no doubt our lawyer colleagues would argue who is responsible for the crime?  Is the criminal the seller of the patient’s predicament or the buyer of the inside knowledge of the suffering?  History teaches us, lawyers will find fault with both parties.

            Is this a slippery slope dentists want to venture down?  Dentists are well educated in HIPPA privacy laws, should we be concerned about targeted advertising, especially when we obtain very personal information such as the wearing of a denture or the loss of a filling?

           I have instructed my employees to be extra diligent in their HIPPA protocol.  Under no circumstance should anyone discuss the loss of a filling with anybody, or we too may get caught up in the world of personal information, targeted advertising and potential HIPPA indiscretions.  





 

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