I had a patient in the office today for an adjustment of his anterior bite plane appliance. When I came in and asked how he was doing he said “great, but I think I melted my mouthguard”. Curious I asked if he had it with him and he reached in his pocket and pulled out a melted remnant of his anterior bite plane attached to the composite. As we looked at it he said “I’m not sure what happened, I followed the directions and only had it in boiling water for 45 seconds to try and tighten it.” For years I have shared the instructions with my patients for tightening their own anterior bite plane appliances at home, this is the first time I have had a patient melt one. I guess that isn’t a bad percentage, but it has made me rethink post-op instructions and how to help them be more clear.
I am in the process of creating an updated office manual over the next few months. One of the key pieces will be the job descriptions for each of the employees on the team. I have had the opportunity to work on job descriptions may times for my own practices and other companies over the years. In the early years i created them, sitting down and thinking through the things I thought a person in a particular role ought to be responsible for. With the job description in hand I then went about finding a person that fit that mold, or worse trying to make the person already employed int hat job fit into what I had written. it was often like forcing a square peg into a round hole, so you can imagine how well it worked.
So in previous posts both Dr. Mark Kleive and I have discussed the concept of a productive and profitable hygiene department. The first step in achieving this is to analyze your hygiene practice separately from the production and collections of the doctors. Once you separate out the production and collections, the next step is to determine what to measure, and of course lastly measure it!! The truth is we only manage what we measure, everything else is on cruise control. When it comes to hygiene monitors one of the top numbers I track is hygiene salaries as a percentage of hygiene collections.
Do you have a system in your office for the management of implant parts? You probably do have some kind of systems if you are doing implant dentistry, but the real question is how well does that system work? One of the things I realized in my office is that our system, or lack thereof was costing us time and money. Making sure we had the necessary parts for implant appointments was handled without rhyme or reason, and sometimes that meant a patient was int he office and the correct parts weren’t. On the other side of the equation we had sterilization bags full of implant parts, unopened parts from the manufacturer and craft boxes full of implant parts. What finally got me was the Tupperware container full of old healing caps, something had to change.
Last week the blog post on Thursday looked at the cause of tooth sensitivity during tooth bleaching procedures. Many of my patients are interested in bleaching and worried about sensitivity or have attempted it int he past and experienced it, so are reticent to try again. There are several techniques we can employ to minimize sensitivity and allow patients to bleach. We looked at the tooth forms of sensitivity caused by irritation of the pulp and fluid movement in the dentinal tubules. With this in mind it makes sense that our management strategies are to occlude the dentinal tubules or calm the pulpal tissue.
One of the barriers to patients bleaching their teeth is sensitivity. Many of them have experienced it, or at least heard about it and are concerned. The sensitivity that people experience during a bleaching procedures come in two varieties. Variety number one is the generalized sensitivity that occurs like an exaggerated version of root sensitivity, called dentin hypersensitivity . The second type are the “zingers’ that occur during in office procedures. Dentin Hypersensitivity and it’s cause are understood, and can occur with many different forms of stimulus. The fluid movement in the dentinal tubules is increased, creating a pull or tension in the pulpal tissue, which we experience as “sensitivity”. Normally the dentinal tubules are sealed with a smear plug. When this smear plug is removed the hydraulic conductance ) ability for tubular fluid movement) increases as much as 32 fold.
In the next few weeks the legislature of the City of Phoenix will decide whether or not to continue fluoridation of the public water supply. The topic is being discussed everywhere, people have very strong opinions, and it is a conversation being repeated in state after state. My e-mail has been inundated with information on supporting continued fluoridation, asking me to speak to patients and take a stand. There are pieces of this conversation I am clear about.
- Water Fluoridation decreases dental disease
- The caries rate will increase without water fluoridation, and increased caries early in life leads to a lifetime of dental treatment.
- Fluoride is not evil and does not have the horrible medical implications those opposed claim.
Recently when presenting in Minneapolis at the Star of The North a conversation came up about managing a single dark tooth during the restorative process. If the tooth has had endodontic therapy one approach is internal bleaching to lighten the stump shade. Often though these teeth have not been treated endodontically, and there is some evidence of increased risk of internal resorption following internal or walking bleach. A friend and excellent dentist that I know joined the conversation and shared a fantastic tip. He explained that if the tooth is treatment planned for a full coverage restoration he uses the provisional as a bleaching tray. Since then I have used this technique numerous times with great success.
Last week I shared a post and video from Mary Osborne entitled “Staying In The Question” and talked about the value of improving our listening skills int he dental profession as a key to helping our patients move forward with care. In this video segment Mary expands on the concept of Staying In The Question and explains a great exercise to do at team meetings to practice being better listeners. I have taught with Mary for years, and we always include the exercise she shares in this video. Over the years I have been amazed time and again at the impact it has on people. Often in our courses dentists and their teams will make a commitment to do this exercise at every team meeting, partnering with different members of the team each time.
In yesterday’s post I discussed the concept of bond degradation, which is the loss of bond strength over time after a restoration is placed. One of the processes we have become aware of around adhesive dentistry is the presence and production of Matrix Metalloproteinases. MMP’s , as they are referred to, are host-derived proteolytic enzymes that become trapped in the demineralized dentin layer. Despite our best techniques at developing the hybrid zone when bonding tags of demineralized dentin extend beyond the infiltration of resin. The presence of MMP’s in combination with demineralized dentin and water results in breakdown and reduction in bond strength over time, what we refer to as bond degradation.