an-everyday-life-journal-of-a-dentist

Have the right attitude!

Tue, 12 May 2015 06:02:34 +0100

When we design a house, we need certain tools like manpower and most importantly, the blue print which designs the structure according to the person's taste and lifestyle. We then hire engineers, architects, interior designers and so forth in order to complete and execute the plan. This is what we call planning ahead.

Likewise in dentistry, when we receive a patient, we don't just go ahead and treat the ailment. At this point, we should focus our treatment plan on a holistic approach where we do not only treat the symptom but everything that is present in the oral cavity that will pose as a problem in the future. No, its not our way of making more business out of that patient. This is simply preparing the patient toward a better lifestyle by changing his attitude towards his or her oral health.

Many of my patients who come to the clinic have had several issues with their teeth. Nowadays, their concern is no longer confined in their oral cavity. Their way of life is generally affected by their insecurities and frustrations regarding their oral health. This greatly challenges me as a dentist because it give me the opportunity to show how dentistry can change their lives. Through a thorough patient diagnosis and exchange of ideas, we are able to effectively communicate on how we can help surpass and even overcome his or her inhibitions toward dental treatment. Keep in mind that no patient who has dental trauma will let you do his or her teeth if your presentation and communication is lacking.

One way of providing comfort and ease is by allowing your patients relate his or her concerns during the first visit. These information will allow you to understand your patients needs and expectations from the treatment. Gathering from this information will help you find the appropriate solution for your patients. This way, you will be able to justify your treatment proposal because they know that you open to their ideas. A good collaboration always precedes trust and when trust is established, your patient will most likely agree to your treatment plan. This way, both of you can work around the treatment that will basically suit your patients. In the end, this will greatly influence them to consider having their dental treatment done in your clinic once you have gained their confidence.

In dentistry today, our attitude should have the flexibility to discern what is right for our patients yet maintain an utmost standard of care that is at par with international health standards. Always look for the best team ( laboratory, consultants, assistants) when you work on a patient because in my experience, they truly appreciate the effort you make to make their patient experience above satisfactory. Never condone a wayward practice (e.g. skipping a procedure, doing shortcuts, disregarding safety precautions and using substandard materials) because in our profession, there are no shortcuts to success. Our success is never defined by the number of patients that come into our clinic but on how we execute and treat our patients well. Having satisfied clients with well-deserved praises are one of the best rewards a dentist can receive.

And above all, keep your values intact when you do your treatments. As the golden says, " Do unto others as you would have others do unto you."

A life changing patient experience

Tue, 16 Dec 2014 14:10:02 +0100

When I was in college, I had my lower left molar extracted by our family dentist. Because I had no inkling of what the procedure would be, I obliged to my dentist and had it removed on that fateful day. Truly it was an awful experience. For one hour and a half, my mouth was open, I was subjected to all the needling, and yanking of my tooth as my dentist persistently removed my third molar. At last, she was able to remove my tooth but then as soon as the tooth was pulled out, I felt a sudden gush of pain in the socket. To top if off, I had a hard time swallowing because the tooth was deeply embedded into the bone. Of all the hardships I encountered, this was one of the most painful experiences I ever had. I told myself, I never want to go through that experience, EVER.

I told my professor about this and he disclosed how pain management is important during these trying times. All things can be resolved when we are better prepared with each case. Pain is the enemy especially when dealing with oral surgery cases. Patients become agitated and restless hence they tend to be uncooperative. When their fear is heightened, we lose our focus. Patients can sense this through our behavior which is why it is important to stay calm when we are in this situation. The objective is to keep your eye on the ball and be patient with your patients. Their experience in your clinic is a reflection of how you conduct yourself at every treatment. When we are conscientious to their needs, you can be rest assured that they will be coming back for an appointment so always put your best foot forward.

The dentist and the dental lab

Thu, 11 Dec 2014 15:09:49 +0100

"Beauty is in the eyes of the beholder."

Over the years of my clinic practice, I have gained the skill of having an eye for detail. Most especially if I am dealing with Aesthetic restorations. I always tell myself, I can never fail the expectation of my patients in terms of shape, size and color. These three aspects are the basic foundation of creating a good restoration. That is why I constantly seek for good labs who can cater to my expectations.

Through this, I have found a new way of replicating these restoration in certain labs who offer in-house procedures where you can directly stain and recreate the shape of the crown without dismissing your patients. When your cases become difficult, you can rely on these labs in assisting you throughout the processing. To me, restoring a single unit anterior crown is more difficult than restoring multiple crowns mainly due to color matching. Taking the right color especially if the adjacent tooth has several hues / translucency can take you forever while casting several glances at your shade guide in order to perfect the color. At this point, the ceramist may have a difficult time staining the crown if the patient is not present. Pictures can be deceiving as well because of its inaccuracies. So the most recommended is by sending your ceramist to the clinic or better yet, bring your patients to the lab for color shade matching.

On several occasions, I was successful with this method because we can see results immediately thereby eliminating more patient visits and adjustments. Moreover, your ceramist will see the problem and can correct the err on the same appointment. Its really a hassle free investment that has given me peace of mind and I intend to continue this practice. Anyway, I don't like the feel of being secluded in the clinic all day so its like my day off from work when I am at the laboratory. In addition, I gain more perspective on a technician's point of view by understanding their methodologies and knowledge. These dental technicians might even give you a good advice on your next procedure. So take lots of notes when you're there.

So when it comes to prosthetics, I rely on my lab's work - through my inputs and guidance, I could say I am doing a great job. Until next time.

Honesty is the best policy!

Wed, 10 Dec 2014 13:34:48 +0100

The truth will set us free!

As I was cleaning the teeth of my patient this noon, I was aghast at what I was looking at. His teeth were in bad shape and what I couldn't help noticing was that the filling on this front tooth was too white next to his natural tooth. Because I could not hold my tongue, I told my patient bluntly that his teeth needs to be fixed. I even expressed that these root fragments are no treasure for him to keep so I urged him to have it extracted immediately. I don't know if it was the way I said it or maybe I was just really stating the obvious but he understood what I was saying and nodded along giving me permission to fix his front tooth.

What I don't understand among patients is, "Why are they reluctant to have their teeth checked, cleaned and fixed?" It just gets to me when patients neglect their teeth and rely on our skill to fix the problem. I would like to say, it doesn't work that way, Dear!

So while I was preparing the tooth, I removed the remaining carious lesion and placed a base liner to protect the pulp before color matching. While building up the tooth, I chose DMG Ionosit as base and Ivoclar Composite on top. And yes, the patient fell asleep during the process which was quite a relief. I felt after all these years, I still have not lost touch with my skill.

After building up the tooth, I trimmed the excess composite with a carbide bur and polished it with polishing discs. I tell you, the finished product was more that what we both expected. High gloss finish that reflected the light naturally. It was pure satisfaction on my part to give him a good smile esp this Christmas. When we finished, I asked him why I had him convinced? He replied, " It was your blunt honesty, Dr that made me proceed with the treatment."

When some would beat around the bush, I went straight to stab it with a knife, hitting the heart where it needs most. Sometimes, patients need our honest opinion on what should be done, and what can be done, as long as we do it to the best of our abilities. They don't need camouflage excuses because the thing is, the truth is never overrated!

Our finished product reflects our work

Tue, 16 Dec 2014 14:17:21 +0100

Its been months since I last visited my blog and I felt compelled to do so because of the need to vent out what has been lacking in our practice. Just today, I was about to install a one unit Porcelain fused to Metal Crown and unfortunately, the bite on the patient was not perfect. I checked the occlusion and the patient had a deep bite. While fitting the crown, the patient's bite changes thereby increasing its vertical height on the side of the crown. Immediately, I realized this is not the perfect occlusion.

Slowly, I carefully trimmed the porcelain and metal away but as I was trimming, I noticed how I was losing the anatomy of the crown. Now, I have two choices. Either I ignore this problem and keep trimming away until we reach the correct occlusion OR I send it back to the lab for construction of a new crown. Lazy dentists would choose the former but as for me, I would like to see more of this patient while bragging her crown among her friends. To me, its such a wonderful feeling when your patients are appreciative of your work despite the long awaited process than to disappoint them for not delivering your work properly.

As I dismissed the patient, I knew she was happy that I was honest with her about the wrong occlusion made on her crown. Had I cemented it in its deformed anatomy, I would never have the peace of mind knowing that I did not do my best. Looking back, I am confident that the next appointment will be better and with the proper guidance to my ceramist, we will correct the mistake made on her crown. Working with a good lab counts because the finished product relies on their craftsmanship. If we accept a case that is not acceptable in anatomical terms, then what good are we here for?

Its true that time has changed me and molded me into a better health care professional. Not only have I raised my expectations, I have also learned to live by my ethics. Until next time.

When passion leads to perfection

Tue, 27 May 2014 16:13:55 +0100

When a dream is given birth, we fire it up with our passion to create something great out of that dream. We become focused, resourceful and most of all, hopeful in every step of the way.

Passion drives us to succeed. We may mix it up with drive and determination but passion ignites our creativity to do more so it amplifies the fire within. It creates an imaginative place of what may become when we achieve this dream. It is the trophy, our prize for beholding that dream.

If a person loses this, he will no longer want to pursue this ambition. He or she may just settle for something that is readily attainable but the challenge has lost its glint. For all we know, many of us have lost that sparkle because the passion was lost forever - but not forgotten.

I may be a victim of a lost cause but the memory of that dream lives within. Now I am challenged once more to do my part in the name of the profession and I do this for a cause. It's not a cliche' rather its a word that will never be overrated.

My passion for being a writer and an editor will never faze out. I know that I was born with this gift and that I will hold this close to my heart. If I ever lost direction at one point, it may be due to some personal disputes I have dealt overtime. But now I have this opportunity to leave a legacy behind, before my time is over, I know that I will succeed in my pursuit. Even if some things don't work out, I know that I was able to share one of my passions to the world.

Upholding ourselves as Professionals

Thu, 06 Mar 2014 08:19:01 +0100

We should never forget what we are and what we uphold as professionals. Our degree and title is our highest honor that we should take pride in. Nobody can defy nor deduce our professional degree because that is borne out of blood sweat and tears. The moment you belittle yourself, people around you will follow.

I observe among our colleagues that they develop a form of insecurity when they are questioned about their profession. Maybe its because other dentists size up their contemporaries based on their acquisitions and the type of practice they hold. But contrary to what some believe, I think that we should not be judgmental over that theory. Some dentists concur to a simple practice out of personal choice and not out of financial inadequacy. When we took our oaths as dentists, we are all stamped with approval by the PRC Board of Dentistry as competent professionals. What we pursue after that is of our own prerogatives. But still, this mentality of judging a person's worth has become rampant to the point where it smears the reputation of our fellow doctors. This deeply saddens me because when it is ingrained in your minds that you are not worthy of your degree then the people around you will have the same opinion that you have developed. May I remind you, my dear colleagues that you make your own choices and those who do not own up to it should not pull down others just to be above them. You have a "crab mentality" that degrades our dentists to the core.

I believe that we are all winners as professionals. We should fend off these allegations and be proud of what we have become. Our destiny lies on our decisions and what we perceive ourselves to be.

Enjoy the fruits of your labors, my fellow dentists!

How ignorance causes problems to our patients

Wed, 02 Oct 2013 11:47:18 +0100

Just today I encountered a reluctant patient who had an aching tooth with pus oozing out of his gums. To his belief, it was caused by brushing too hard on his gums and was reliant on taking antibiotics alone rather than having his tooth extracted due to dental decay. Upon examination, it was badly carioused and emitted a foul smell yet he is still convinced that it was his harsh brushing that caused the bleeding. With all my efforts, I told him how tooth decay can cause a foul odor smell that can lead to periapical abcess. I even showed him diagrams and told him that he can ask for a second opinion from another dentist to validate my observation. But to my dismay he looked more convinced that ANTIBIOTICS is a better option so I gave him what he asked for - a prescription for antibiotics to "TREAT HIS PIMPLE-LIKE INFECTION."

I felt sorry for the patient because I don't know how he can go on with his everyday life relying on a wrong notion that antibiotics heal tooth infections. I really wanted to say to him, please be reminded that ANTIBIOTICS ARE ADJUNCTS AND NOT TOOTH HEALERS! They only support the healing process but you cannot totally rely on its efficacy just because the swelling has subsided. Yes, it will subside for the time being while your body is absorbing the antibiotic but within 72 hours after the antibiotic has been flushed out of your system, the infection will exacerbate because you have only put the infection to sleep. Once it builds up again, the infection will come back with a vengeance.

I always tell my patients how antibiotics can help in the healing process, but never did I claim that antibiotics are the best choice for tooth infections. I have gone that road myself where I experienced excruciating pain in the wee hours of the morning because of a tooth infection and believe me, it was not a good experience.

I wish all our patients would listen more to their dentists especially when they have tooth problems. I believe dentists are the best people to seek advice from than pharmacists or any other professionals. After all, that is what we specialize in. When in doubt they can always seek a second opinion if they want to validate the diagnosis of the dentist. Besides, they won't lose anything just by asking, right? Ignorance is not an excuse nor should it be a hindrance towards health and awareness. Being aware only means that you are willing to make your life better by making the right choices and it does not exclude your oral health.

Until next time.

Making friends, establishing connections

Mon, 23 Sep 2013 04:07:03 +0100

Dentistry is no longer just a profession. It is a business opportunity. After all, we make a living out of it. We build, establish, gain connections - its a due process waiting to unveil. A few years back, I made a friend out of a patient who almost became a hostile entity in my life. It came to a point where I would dread her appointment because all I could hear were complaints. And she became irrational to every explanation I gave to her. I felt my hands were tied and that I was at her mercy.

I wondered, what if I ignored her and never showed up at all, eschew her whenever she would contact me. But my heart was so soft that I could not bear turning my back on my patients knowing that I have an obligation to fulfill. Frankly speaking, those times were a nightmare for me but I manned up! I showed her that I was responsible and that I will finish the job no matter what it takes. Because of that trait, I guess, I gained her respect. Later on I realized, she wasn't the drama queen I thought she was. She was actually a patient who needed to be heard because she has longed for a dentist who will listen to her concerns. Out of that situation, I have made a friend and five years have passed and we have remained where we are today. A good doctor patient rapport was established.

I believe that in our profession, we didn't take up psychology in our pre-dentistry for nothing. Many times, patients who are troublesome need to have someone they can talk to - and many times have these patients of mine confided in me telling me about their happy or sob stories because they feel being in the chair relaxes them. If my chair could only speak, it would tell you a lot about my patient's stories.

Now going back to my patient, because we became good to each other, she now actually refers me to her colleagues in an international organization. Today, I enjoy having my old friends and seek for more new friends to establish more connections. So it seems, my patience paid off. I stood up, I endured, and I conquered. Not a bad aftermath after a hard days work.

The irony of simple extraction

Mon, 09 Sep 2013 14:09:10 +0100

Have you ever had an incident where you extracted a wisdom tooth in just minutes and extract a badly decayed tooth that took you almost an hour to remove? I have had my share of bad experiences and frankly speaking, I do not enjoy this at all. To me, I chose oral surgical specialty because I know that I am good at what I do. But when certain matters happen where the bone of the patient is too dense and extraction becomes difficult, it is such a frustrating moment for me. That's the time where I wish I had not tried to be a hero and just deferred the treatment at another appointment.

After years of experience, I have learned a lot in this profession what dentists should and should not do when faced with extraction cases.

1. Never to extract a tooth without a periapical radiograph.
Radiographs are essential in extraction because it gives us an overview of what we will encounter during the procedure. Contrary to popular belief that it's our way of generating additional income, radiographs help dentists address the case properly. A tooth suffering from dental abscess can lead to other heart diseases or spread throughout the system if it is not foreseen during diagnosis. Failure to diagnose can be detrimental to the health of the patient. So if the tooth is found to have a periapical abscess, it is important that we put the patient under antibiotics. This will help treat and localize the infection and most of all provide a profound anesthesia once you extract the tooth.

Believe me, this will save you time and effort plus it will less likely hurt the patient during extraction.

2. Administer antibiotics as necessary
Antibiotics is the first line of defense of the body against infection and helps increase the immune system. If the patient has the adequate dose of antibiotic, the existing tooth infection will be properly treated prior to extraction. This is most true to cases that have active tooth infections. As soon as the inflammation subsides, you can easily extract the tooth without a sweat. Plus, you get praises from your patients for removing the tooth so quickly and pain-free.

3. Suture your extraction wounds
In my practice, I always suture to protect the clot and veer the debris away that may be lodged into the wound. Even if it is just a "simple extraction", among the objectives of suturing the wound is to stabilize the clot leaving it undisturbed as it heals away. As a result, I get beautifully formed gums and satisfied customers.

4. Recall the patient for evaluation
This is what I call extra service where you are going the extra mile for the health of the patient. You ensure that all is well after the extraction and have the chance to interview your patient about his experience in your treatment center. By doing this you can be assured that this happy customer will refer more patients to your clinic.

Keep in mind that there is NOTHING SIMPLE in our profession. We are one of the in-demand jobs in the field of Medicine that requires both the skill and the knowledge working at the same time. That's why we should never underestimate a case even if it may look so simple on the outside because once you perform the procedure, there is no other way to do it but finish the job.