Thumb Sucking

Although I have addressed the issue many times in other posts, I just realized I don't have a specific post on Thumb Sucking.  I hear all the time, "how do I get my child to stop sucking their thumb?"  Well, here is a rundown of some general advice that I give in the office. Basically, lots of kids suck either pacifiers, thumbs, or one or more fingers (digit sucking).  I will concentrate this post to thumb sucking as most information on pacifiers is here:  Pacifiers

What is going on:

1.  Pacifier and thumb habits in preschoolers are very common.  Kids find comfort in the habit.
2.  Sometimes these habits affect the teeth and jaws, sometimes they do not.
3.  There is often an associated habit that goes along with the primary habit.  For instance, a thumb sucker may hold a favorite blanket or twirl their hair.
4.  The habit tends to get worse when they are upset, tired, zoned out in front of the TV, or otherwise not occupied with other activities.
5.  The kinds of problems that involve teeth tend to fall into three categories:
     a.  Overbite, or protrusion of the upper front teeth, sometimes with the lower front teeth going backwards.
     b.  Open bite, or an opening of the front teeth to accommodate the thumb or pacifier.
     c.  A Posterior Crossbite or constriction of the upper arch resulting in the teeth shifting to one side or moving totally inside the lower arch.
6.  Anything in the front teeth, like overbites will tend to correct on their own once the habit is stopped--so long as it is in the primary dentition (no permanent teeth involved).  Posterior Crossbites do not tend to correct themselves and often need orthodontic correction.

What to do about it:

1.  Ok, first, there is no magic cure or magic technique that always works to get kids to stop sucking pacifiers or thumbs.
2.  Almost all kids eventually stop the habit, sometimes sooner, sometimes much later, but you don't see too many 25 year old executives sucking their thumbs--at least in public.
3.  Most kids who suck a pacifier stop by the age of 3 and a half.
4.  Most kids who suck fingers or a thumb stop a little later, about 4 and a half years of age.
5.  Because thumb and digit habits tend to persist and seem to cause more adverse dental movements, I prefer a pacifier habit to a thumb.  Of course, the child usually decides what they like the best, not us.
6.  If a habit persists beyond a time where the parent feels uncomfortable or it's getting close to the time for permanent teeth to come in (around 5 years old), then you can try the following things:

     a.  Gentile reminders are usually the first step--not scolding- (that can make things worse).  Get them occupied with other activities or interests.
     b.  If you are seeing a general decrease in the amount of sucking, then you are on the right track.  Although, do not be surprised if things relapse a little if you move to a new house, have a new baby brother come along, or otherwise have a disruption in their normal routine.  Night time sucking is the last to go, and the most difficult to stop.
     c.  You can try that yucky stuff you paint on the thumb to inhibit sucking.  This tends to work better on older children.  Even then it only works about 10% of the time, but it's sometimes worth a try.  Here is a website for the stuff (which is yuckier than when we were kids): http://www.stopbitingnails.com
     d.  What if that does not work?  There are all kinds of things out there to prevent sucking, like things that you put over the thumb to inhibit the habit.  These things tend to work best if the child really wants to stop, but just needs a reminder from time to time.  One of the most interesting ideas I remember is to get a long sleeve tee shirt and sew the sleeve opening up.  The child wears this as a nightshirt.  These kinds of things can initiate a lot of angst on the child's part and are usually very frustrating unless the child really wants to stop.
     e.  There are good behavioral techniques I have seen speech pathologists use to get kids to stop.  Sometimes it seems like magic.  So, a dentist may refer you to one of these folks to give it a try.
     f.  Ok, if all that does not work, we dentists can make a thumb guard which is a dental appliance you attach in the mouth with orthodontic bands.  This child wears it all the time.  It usually has wire loops up behind the front teeth that inhibit the placement of the thumb the way the child likes.  It actually works most of the time.  The key is it is usually not used on preschoolers.  This is for kids who are into the permanent dentition, usually about 8 years old or older and is often followed by orthodontic treatment (braces).  Crossbites can be corrected with a simple orthodontic appliance.

Rising DAT scores

The DAT or Dental Admissions Test measures a dental school applicant's potential for success based on performance in several academic disciplines.  Here is a graph of the rising competitiveness of scores in recent years:

I cannot emphasize more how competitive it is to get into dental school these days.  You must have very good grades and very good DAT scores.  After research and studying recent trends and speaking to Deans of dental schools, I can say with confidence that it is harder to get into dental school than medical school.  I have heard of someone saying, "If I don't get into dental school, I can always fall back on medical school." Wow, how times have changed.  In fact, even since I wrote my book and alluded to the increasing application/acceptance ratio to dental schools these days, there has been an increase in the number of applications for the limited slots available.  There is a rapidly rising number of applicants and the quality of those applicants is rising very rapidly as well.

Read more in my book: "Dental School: Preparation, Survival and Success"

Get Those Requirements

In my book, Dental School, I mentioned the trials and difficulties of the dental school experience.  One thing I would like to bring out more is the relentless pursuit of "Requirements."  What do I mean?  Requirements are the need number of specific procedures you must accomplish to pass or to graduate.  These are things like a specific number of crowns, dentures, root canals, or two surface fillings you must complete.

It always seemed in my experience and in those with whom I talk to, that it was difficult to get these done in a reasonable time frame.  What if the patient you have acquired or been assigned needs three fillings, one root canal and one crown?  That's great, but you need to do a periodontal surgery crown lengthening and a post and core buildup prior to the crown.  Moreover, the only thing you really need as far as requirements is the crown.  In some schools you have to get all the necessary work done on the patient, much like in the real world.  In some other situations, you may be able to have someone else do the root canal and surgery, then you do the crown, but that can take a while before you get it done.

The thing I want to emphasize is the drive to get the requirements.  It's not always easy.  Some schools are having a more difficult time getting patients as more and more are treated by private practitioners.  I know some pediatric residents that do only one or two premed (sedation) cases prior to graduation.  In practice I do one or two sedation cases a day.  Experience is an important part of developing and perfecting a skill.  The more you do the more you know how to deal with the little variations in each case.  Requirements are just the way schools have of making sure a dental student gets at least some basic minimal experience before awarding a degree.

10,000 HOURS

Malcolm Gladwell, in his book "Outliers", puts forward a well researched observation regarding the topic of skill and mastery.  He states that it takes approximately 10,000 hours of concentrated activity to become a master or expert.  He gives examples of concert pianists, sports figures, computer programmers and even The Beatles, who spent many a weekend performing and refining their music and performance skills in clubs well before becoming known to the wider world.  How long is 10,000 hours?  Ten thousand hours comes to working 8 hours a day 5 days a week for at least 5 years.

How does this apply to dentistry?  The art and science of the dental profession certainly falls within the definition of something that is difficult and complex, not only intellectually in diagnosis, knowledge and assessment, but the use of physically demanding and precise surgical techniques.  While there is a certain amount of innate talent and certainly compassion involved, the true mastery takes a long time to develop.

In Pediatric Dentistry, it pretty much takes at least that long.  A new graduate knows a lot, but has not yet mastered the art of the profession.  In fact, in dentistry, we call it dental "practice" because you are really never done learning and improving.

I am humbled that, although I have gone well past the magic number of hours, I still am refining, learning, and relearning how to practice with a certain degree of mastery.  In fact, I think the rule for dealing with children (and their parents) on a daily basis should be closer to 20,000 hours, or maybe a lifetime!

So, if a dentist with many years of experience takes a look and says he is concerned or offers an opinion, you might be well advised to listen.

"Outliers" by Malcolm Gladwell

Dental School is Exactly Like This

Dental School is Exactly Like This.  Ok, well, maybe not exactly.  Still, dental school was certainly an awesome experience.  I'm sure we could have made such a great video in our day if we had the technology.  In fact, weirder things than this are know to happen.  Hat tip to UNLV School of Dental Medicine.

Buy my book on Dental School click here.

Double click the youtube video for option of full screen.

Social Media, Everyone Is Doing It?

The most recent buzz in dentistry is Social Media.

I get all kinds of inquiries from dentists who want to know how to write a blog, how to set up a Facebook page.  They want the newest thing, they do not want to fall behind and loose market share.  Still, I think there is a problem.  First, there is the problem of over-saturation, of dilution; everyone's doing it.  The second concern is that most dentists know dentistry, but they have no idea how to use the tools of Social Media.  They all have a web page, Facebook and Twitter accounts, but rely on someone else, or no one at all, to actualy run the pages, post the comments and photos because they have totally missed the point.  It's a dead end for them.  It's useless.

You know there was a time when almost no dentist even had a web page.  Advertising, as it existed just a few years ago was yellow page ads.  In my college economics class, before I was even in dentistry, I asked my professor about something I had noticed.  Some dentists were beginning to advertise.  It was frowned upon for dentists to advertise back then.  It was unprofessional.  Really, this was a pervasive attitude.  It was allowed, but you had to put all kinds of disclaimers in any announcement.  The only thing you were "allowed" to do was announcing the opening of your practice in the local paper and later on, your retirement.  Now, there were a few dentists back then who were beginning to put "ads" in the yellow pages.  These were fairly minimal things; a quarter of a page max.  These dentists enjoyed what you might expect from the increased visibility, an increase in business.

I asked my economics professor, what happens when more and more dentists advertise too.  You know,  just to keep up and compete?  He said the first adopters would reap the most bang for the buck.  Once it spread and most if not all were doing the same thing, the benefit would diminish.  Everyone would be back to square one, but with a higher monthly bill for advertising.

These days we do not advertise, we do "marketing".  It's more accepted to put your practice name out there on billboards, TV ads, etc.  There is a reduced stigma.  There is nothing wrong about telling people what you do and where you are located and educating people about your profession.  There is still a concern about deceiving the public, about presenting oneself as something you are not.  For instance, a general dentist saying he does braces is one thing, but saying or implying he is a specialist, an orthodontist, is unethical and in most states illegal.

So, what is the newest thing in marketing? -Social Media.  Dentists are being advised to not only have a webpage, but a business Facebook page, a locations page, a Twitter account and a Blog.  This is good as these are modern vehicles for not only information, but interaction and education. I love it. I started this blog in 2006 and had a Twitter account before most even had heard of it much less understood what it was.  Still, I wonder as more and more dentists get on the bandwagon of "Social Media" that a dilution effect will ensue.  This time perhaps not, at least for those who know how to actually use Social Media.  It is so sad that there are so many physicians and dentists who hire someone to establish their webpage, set up their blog and Facebook Page.  Then they just sit back and expect it all just to run itself like the yellow pages of old.  This is so off the mark.  You have to actually engage, interact, update and communicate on these sites.  It just doesn't work without that level of energy, interaction, and caring.  You can't take the Social out of Social Media.

So, Facebook, Twitter, videos, and blogs are all things that can help a practice grow and thrive in the 21st century.  The key is actually knowing how to use these new tools properly.

What Is Your Favorite Toothpaste?

What is your favorite toothpaste?  Which toothpaste is the best?  Most all toothpastes have the same amount of fluoride.  The ones that do not are those few marketed as natural, or the ones made for babies and toddlers that are sometimes called something like "tooth and gum cleanser."  You will find that fluoridated toothpastes are recommended for adults and children two years and older.  Even then I recommend only a very small bit of toothpaste on the brush so if a child swallows it (which they will do) then its just a little bit and will cause no real problem. Other than fluoride though, it's all about the other stuff, the whitener, Triclosan, the tarter control, the appearance and of course the taste.  Really none of the effects of toothpaste are more important than the fluoride.  The ADA seal is to attest to the fluoride content.  That's the stuff that helps prevent cavities.

So, which toothpaste is the best?  For the children I see in our practice, the one I recommend to them is the one they like the best; the one they are motivated to use.  It's all about the marketing, sparkles, smell and taste.  Some kids, usually very young ones, don't like any kind of toothpaste.  Hey, you can still clean the teeth with the brush and floss, but the advantage of the fluoride is not there.  Most toothpastes marketed to children have the same fluoride content (1000 ppm) as adult toothpastes, but often have bubblegum or other flavors that appeal to children--and sparkles!  Adults like the minty flavors more.

So, which one do you like the best?  What is your favorite toothpaste?  I like Colgate Total enamel strength stripe and the Crest Pro-Health For Me Minty Breeze.  It's not that these are any better than others, it's just the awesome taste, sort of a mild mint that I prefer.  It often comes down to what you like.  If you do find something you like, it's ok to try something different from time to time just to keep it interesting.

Dental Schools Are Opening All Over The Place

In response to rising demand for a dental education back in the late 1970s and early 1980s there was a large increase in the number of dental students matriculating in dental schools across the nation.  Some of this was due to federal funding increasing the number of slots available.  After a while, this led to what some called an oversupply of practicing dentists leading to a wave of unforeseen changes in the business of dentistry, namely the introduction of managed care dental plans and increased competition.

In time the cost to the schools of providing a dental school education began to rise and some, mainly private, schools began to close; schools like Northwestern, Georgetown and Emory.  

Recently there has been an increase in the number of schools opening or planing to open across the country.  I do not know what long term effect this may have.  It will be interesting to see what happens and how this might affect dental school admissions and graduates.  One planned school at the University of Central Florida has been put on hold. I do hope these new programs will provide a great educational experience and not just become a profit center for the parent organization with little actual training or education for the students.

More information on Dental School can be found in my new book.

See my previous post on dental school admissions applications vs. the slots available

Continuing Education--"CE"

Continuing education, otherwise known as "CE," is a constant in any profession.  School does not end with graduation. A dentist must constantly keep up with not only the newest techniques and materials, but also re-learn what has since been forgotten.  In my state we must complete at least 20 hours of CE every year just to keep our license. This is actually quite a low number, as many I know have many more hours than that.  Continuing education, and the associated credits, is usually be obtained by attending lectures, courses, local meetings, national conferences, and hands-on classes.  Online courses are also useful and becoming more common.

Back in the old days physicians and dentists would learn by didactic or "book learning" but also by observing procedures and surgeries.  Anesthesia using ether for surgery was first demonstrated in the "Ether Dome" at Massachusetts General Hospital in Boston.  You can see this lecture hall/operating room still today.  I visited this historic place several years ago.  The benches are quite steep so "students" could observe the activities below.  So, learning is a continuous process.  Your dentist probably is spending more hours in lectures on weekends and evenings than you know.  This is why we call it dental practice.  We are always practicing and learning.

How Hard Is It To Get Into Dental School?

How competitive is it to get into dental school?  I have addressed this in my book in some detail, but want to add this interesting chart (I hope you can see it-click it to enlarge slightly):

This is a long term view of the popularity of dental school.  The red line is the number of applications, the blue line is the number of positions available.  In the year 2010, there were 12,202 applications for 5089 slots.  There are times where applications fell and other times where the number of applications rose.

You can see the overall trend that there are more applications per opening now than in the recent past.  So, is this a more competitive environment?  Yes.  However, this is data can be somewhat misleading if you are to conclude one has no chance.  Decisions on entrance are made one student at a time.  If all the additional applicants in recent years have a less attractive resume than you, then it does not matter as much whether there are more applicants or not.  Still, usually these are top notch applicants.  In fact, I have some data that indicates the "quality" of the applicant pool in increasing.

The striking thing to me is the greater desire of students to select dentistry as a career and the rather limited number of slots in dental schools to meet that demand.  That, "bulge" in the blue line in the 1976-1983 time frame produced a large number, some would say a glut or oversupply, of dentists that are still practicing today.  They will be retiring over the next 10 years.

I have talked to many a physician, and have seen medicine become a less attractive field than it might have been in previous years.  Also, in times of economic downturn, the stability of a profession like dentistry becomes more attractive--and more competitive.

More info can be obtained in my new book:

Dental School: Preparation, Survival and Success available on Amazon.

Dental School-My New Book Is Now Available!

My new book, "Dental School: Preparation, Survival and Success" is now available.

Many times on this blog, people have asked questions about the dental school experience.  They have asked, "How do I get into dental school?"or, "What courses should I take?"  I have compiled answers to these and many more questions into my new book.  It is now listed on Amazon.

Have you ever wanted to become a Dentist or Orthodontist?  This book covers not only how to get in, but what dental school is really like, how to excel, and how to succeed the difficult years of study. Postgraduate residency in specialties like Orthodontics, Oral Surgery and Pediatric Dentistry are covered in addition to business aspects of the profession and options after graduation including setting up a practice and employment opportunities.  I have also included a section on The Internet, Dentistry and Social Media.

If you or anyone you know is considering dental or medical school, or you just want to find out what it takes to become a dentist, this book will provide lots of answers.  I have included data on tuition and financial costs, the DAT, in addition to personal experiences and advice.  Some highlights:

-Is dentistry right for you?

-How to get admitted into dental school

-What courses to take in high school and college

-Tuition and financial options

-The dental school curriculum

-How to overcome the challenges of dental school

-Specialization and postgraduate education

-Business and employment opportunities

-A special section on Dentistry, the Internet, and Social Media

The foreword is written by Dr, Nido Qubein, the president of High Point University.

Please purchase the book and write a great review!  Here is the link to the Amazon listing:

"Dental School: Preparation, Survival and Success"

(click to enlarge)

Dental School - My new book is now available

My new book, "Dental School: Preparation, Survival and Success" is now available.

Many times on this blog, people have asked questions about the dental school experience.  They have asked, "How do I get into dental school?"or, "What courses should I take?"  I have compiled answers to these and many more questions into my new book.

Have you ever wanted to become a Dentist or Orthodontist?  This book covers not only how to get in, but what dental school is really like, how to excel, and how to succeed the difficult years of study. Postgraduate residency in specialties like Orthodontics, Oral Surgery and Pediatric Dentistry are covered in addition to business aspects of the profession and options after graduation including setting up a practice and employment opportunities.  I have also included a section on The Internet, Dentistry and Social Media.

More details on my post here:

Dental School Book

The Future of Dentistry: Technology

How will technology affect dentistry?  Well, technology is already playing in increasingly important role in this age old profession.  Here are the major developments I foresee:

1.  Diagnostic technology such as digital radiography (x-rays) will continue to become more common. Digital Panoramic and intra-oral x-ray machines will completely replace chemical films and developing.  Computerized image management software will be able to store, display and enhance digital images.  3-D imaging will become more common.  Instead of several intra-oral films, panoramic and cephalometric x-rays, yucky impressions for models and photographs, there may only be the need for one imaging machine or technology which can do all of the above.  Computerized diagnostic software will be able to detect and identify decay and other anomalies and pathology

2.  There will be continuing development of information technologies for the business and record keeping end of dentistry.  As in most health businesses, physicians offices, hospitals, etc., there will be even further incentives for electronic medical records (EMC), computers in the dental office for scheduling, management of financial and patient records, and insurance claim filing.  Ipads, flat screen TVs, and digital entertainment will become more common.

3.  Laboratory technology, which I have often viewed as remaining in the dark ages using proven but old techniques, will transition to CAD/CAM (Computer Aided Design/Computer Aided Manufacture).  This may manifest as in office or laboratory fabrication of crowns and other prostheses by computerized milling machines and digital printers.  Intra-oral cameras will advance to be able to easily take virtual impressions of teeth and transmit the information for production.

If you are in doubt about the impact of robotics in medicine and dentistry, check out how wearable robotics developed by the military are helping paralyzed individuals walk:

                 click photo for link: Wearable Robots help Paralyzed warriors walk again

4.  Currently lasers are used for soft tissue surgery and some hard tissue preparation.  A little further into the future, there may be new devices to more efficiently and simply prepare (drill) teeth for fillings, crowns and other things with more precision and less effort.  Orthodontics will reduce treatment time and accomplish previously difficult tooth movements using new techniques.  Perhaps even stimulation of bone remodeling to speed up tooth movement.

5.  Diagnosis of at-risk patients, targeting medications to particular problems will become more sophisticated.  The use of DNA techniques in diagnosis and treatment will continue to advance.  A caries vaccine?  -They have been talking about that one for 20 years so I do not anticipate an effective vaccine in the near term.  Techniques to replace teeth with laboratory grown teeth for a patient's own DNA or tissues may become a reality.  Advances in oral surgery including nanotechnology in the targeting of cancer cells will enable less traumatic and more successful treatment of these debilitating and often fatal diseases.

6.  Newer techniques of anesthesia and the development of new medications will make dental care even more pleasant and comfortable.  Safer and more effective sedative agents and/or advanced anesthesia techniques will enable any surgical procedure to be completed more easily for the patient and the doctor.

What might all this mean for the practicing dentist?  Well, you cannot say that just because a great technique exists that it will be incorporated into daily routine practice.  There are so many other things to be factored into the equation.  Financial issues and/or insurance may or may not pay enough to make these technologies feasible.  Patients may not be willing to cover the increased cost to use a $100,000 machine to do just a few minor procedures.  I do know many of these technological advances will make dentistry more efficient.  There may be a need for fewer laboratory technicians, but the ones remaining will be skilled in these new techniques.  There may even be a reduced need for as many dentists as each dentist becomes able to accomplish more treatment.

St. Elsewhere

While in my residency, I did an anesthesia rotation at Charity Hospital in New Orleans.  As Pediatric Dentistry residents, we spent every day for a month providing anesthesia for all kinds of surgical cases.  Later on, we did a rotation at Children's Hospital.  During these rotations, with often minimal supervision, we started IVs, calculated and administered medications, intubated the patients and provided whatever was needed to keep the patient asleep and alive during surgery.

Video:

It could be stressful, as we were no as familiar with the OR as the medical residents.  Moreover, Charity was a unique place.  It was built like Fort Knox with 24 operating rooms on the 12th floor.  It was an old building and had an eerie St. Elsewhere atmosphere.  In fact, it seemed every time I entered the building, I'd hear the theme song from that TV show.  We didn't get too much help from anyone there and kind of had to fend for ourselves, scrounging up supplies.  If you didn't have an IV setup or a pulse oximeter, you'd just "steal" one from an adjacent unoccupied operating room before someone was the wiser.  We also sat in on anesthesia resident meetings.  Some of the surgeries were interesting to watch.  Of course, we were actually quite busy keeping the patient monitored.  There were orthopedic cases and a few jaw reconstructions, sometimes abdominal surgeries, but mostly minor stuff.

Every now and then they brought in patients from the local prisons for treatment.  One day one of them escaped and somehow in the ensuing melee, was chased outside, where the police promptly shot him.  They brought him right back in the hospital to get patched up and go back to jail.  That was a typical day at Charity.  Of course Charity became even more infamous during hurricane Katrina.  I was so glad to finish with the rotation, but was thankful to have had the experience.  I learned a lot about sedation and anesthesia.

3D Orthodontic Scanner

Here is a new device we at APDA have just acquired for our practice.  It is a 3-D scanner.  What it does, is scan a dental impression and create a digital or virtual model of teeth.  It can also scan plaster models so you can dispose of the plaster cast and have a record in three dimensions of the patient's mouth.  These models are used in diagnosis and for instructional purposes.  Diagnosis is the most important part of any orthodontic (braces) case.

Plaster casts or models are the nemesis of Orthodontists.  There are rumors of Orthodontists being killed because the hundreds and hundreds of orthodontic plaster models they store in their attics collapsed on them from the immense weight.

This new robotic device scans the impressions (you know the yucky stuff they put in your mouth to make in imprint of your teeth when you get braces).  Usually, plaster is poured into these impressions to make a model of the teeth which aids in diagnosis of the orthodontic case.  The scanner uses a laser light to scan the impression in different orientations.  Then a digital image is produced on the computer replication what the plaster model would look like.

So, no more plaster models!   Here is the digital result that can be rotated and displayed for the orthodontist and the patient to view.  Maybe someday we can do away with the yucky impression altogether. (they are actually working on that with 3d x-ray machines.  One x-ray gets the panoramic, cephalometric, and models with just one image).

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Our New Website

Ok, finally we have our new website up and running.  Check it out!  I am sure we will be editing the text and adding features and videos as time goes on, but here we are!

http://www.alabamapediatricdentists.com

Pediatric Dentist or Pedodontist?

Pedodontist is a word that was used for some time to describe the specialty of dentistry devoted to the treatment of children.  "Pedia-"or "Pedo" means child or children; "-dontist" denotes one who studies teeth.  The old word was found to be confusing.  Some people thought it meant foot doctor or something.  The modern accepted term these days is Pediatric Dentist or Pediatric Dentistry.  The term was changed a few years ago, but you will still hear the older term.  Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

I came across google "ngrams" search engine.  This searches millions of books published over the years and finds certain terms or phrases.  See if you can see when one term fell out of favor and the other is now accepted.


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Practice Management Consultants

Do dentists need consultants to advise them on practice business issues?  Well, in my opinion, sometimes yes, sometimes not so much.

There are a myriad of dental practice consultants.  Some are individuals, some are larger firms that advise dental practices on scheduling, marketing, compensation, staffing, customer service, phone skills, billing and other financial and people issues.  Do dentists need to master these issues? Most definitely yes!  Dentists, especially those in solo practice, (which is most dentists) are prone to try to do everything themselves.  In my experience practices can improve if they establish appropriate systems or ways of doing things that are appropriate for their particular situation.  Consultants can help, especially in young practices or those more established practices who are having problems and that have never done a systematic analysis of what they are doing well and what they are doing not so well.  They need good systems.

Over the years, our practice has had many consultants come in and give advice.  We have developed, established, and refined systems. Of course, we still need to adapt and look at new ways of doing things.  Even good systems can become ineffective over time.  Newer staff do not remember the reasons certain methods of doing things were originally established.  Management gets distracted with other issues and lets good systems wilt.  New issues arise.  A good consultant will adapt any analysis and advice to each practice.  Still, I have found that there is a certain point where most advisors simply cannot offer any new or effective ideas.  They tend to charge a lot of money to come in and tell you what you already know.

Good practices, especially well managed larger group practices like ours, have already tried and refined 95% of what is out there.  We have management that is able to analyze data and focus on what works for us.  At this time, there are simply not that many multi-specialty Pediatric Dentistry / Orthodontic practices out there, so consultants do not have a good database to develop useful ideas.  Sometimes I think we could teach them a thing or two.

One time, we specifically asked a well known consultant not to cover certain basic topics we had already addressed, but to focus on certain new concerns we had.  They proceeded to do what they evidently did with all practices, spending an entire day covering the stuff we told them not to waste our time with.  We fired them the next day.  Cookie cutter approaches are not appropriate for most situations.  So, with few exceptions,  practices like ours do not benefit as much from dental practice management consultants.  There is simply a point of diminishing returns.  We can direct our resources, time and combined expertise to determine what works best for us.  Yes, we still need outside advice on financial, technical and legal issues, but for the most part, there seems not much value for unique practices like ours with the management consulting industry as it stands today.  Again, many practices do need advice.  I am not dissing the consulting industry, but a business needs to do what is right and prudent for them.  Sometimes dental practices can benefit from expensive practice management consultants, sometimes not so much.

Abbreviations and Acronyms in Pediatric Dentistry and Orthodontics

You may hear some shorthand or slang terms around a dental office. Hopefully, you will not hear anything like I heard once like this conversation a staff member had with a patient.  "Your O-H is pretty good but we are sending you over to Ortho to get some Records and see if you need any e-x-tees.  I don't see you in TPL, so I'll check Dolphin to see if your Pan is in there."  What?

Abbreviations and acronyms are very common in today's society.  The military tends to bring it to an art form.  In the dental office, doctors and staff often forget that patients are not in the office five days a week and do not use the shorthand language understood by staff.

Here is a list of a few common abbreviations, acronyms and slang heard in some dental offices:

E-X-T: Short for dental extraction or removal of teeth
ORTHO: Orthodontics or braces
PAN: Short for a Panoramic Radiograph (x-ray)
I-R-M: Intermediate Restorative Material (a temporary or sedative filling)
PEDO: Short for Pediatric Dentistry
Computer system terms peculiar to each software such as TPL (the list of that day's patients)
FILTEC or DYRACT: Particular brands of composite (white filling) material.
O-H: Oral Hygiene (status of brushing and flossing)

This is not to mention the confusing array of dental nomenclature and terminology that is a normal part of dentistry like condensers, plastic instruments, ball burnishers, spreaders, burs and forceps.  There is also a whole collection of terms we use in Pediatric Dentistry to help children understand what is going on.  See my post on Pediatric Language on that subject.  Hopefully your experience in our office will be one of friendly communication that is actually understood.

Indirect Pulp Cap

What is an Indirect Pulp Cap? For that matter, what is a direct pulp cap? I was asked this in the comment section of a few other posts, so I though I ought to clarify.

An indirect pulp cap, if done properly, and in the right cases, can help avoid the need for a root canal in severely decayed teeth.

An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. As a dentist, you find that the decay is extensive and very close to the pulp (nerve) of the tooth. In fact, it may be likely that if you did remove all of the decay, the pulp would be exposed by the infected decay thus resulting in the need for a root canal. So, in order to avoid a root canal, the last little bit of decay is left in there and a sedative temporary filling is placed, usually IRM. After a few months, the temporary filling is removed and the remaining decay is removed and the tooth restored. How does that work? In teeth that have no signs or symptoms of pulpal necrosis or abscess, and that seem to have a good blood supply (ie, the younger the patient, the more likely it will work), by removing the bulk of the nasty decay and sealing off the remaining decay from its nutrient source (the mouth), the pulp has a chance to repair itself and what I call, "scar away" from the decayed area. Once this secondary dentin layer is in place, the remaining decay can be removed without pulp exposure. It doesn't always work, as many teeth are too far along and cannot recover, but sometimes it is worth a try.

A direct pulp cap is where there is an actual exposure of the pulp and a medicament like Calcium hydroxide or Mineral Trioxide Aggregate (MTA) is placed to stimulate the secondary dentin formation. A direct pulp cap is usually done with small mechanical or traumatic exposures with no evident decay in the area.