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Howard Speaks Howard Farran, DDS, MBA, MAGD

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The Four Biggest Problems in Clinical Dentistry

Howard Farran, DDS
MBA, MAGD
Publisher,
Dentaltown Magazine
 Every day, dentists face a myriad of clinical problems. Scheduling issues, time management, problems with lab work, emergencies, non-compliant patients and unreasonable patient expectations all contribute to boosting your stress level. However, all of these issues may seem microscopic when put up against what I think are the four biggest overarching problems in clinical dentistry.

1. The first biggest problem I see in clinical dentistry is "herodontics." This applies to dentists who try to save everything that comes their way. If I had a dollar for every lesson I learned the hard way I could spend a month in Europe!

Should you retreat a bombed out molar root canal or should you extract it and do an implant and crown, or a three-unit bridge, or add a tooth to their partial? Should you really be doing a root canal, build up and crown on an anterior incisor without a 3mm ferrule or extract? The worst part about herodontics is when those patients show up in your office 12 months later with the tooth in their hand and say, "I just spent $2,000 on this tooth and it only lasted a year." Then your guilt tells you to credit the $2,000 to the implant and crown, or a three-unit bridge. Now you are working at a huge loss, the patient is unhappy, you look incompetent, the patient questions your work and your day has just been ruined. You might even have lost that patient forever. How messed up is that?

It's not your fault that your patients don't brush properly, don't floss at all, eat sugary sticky foods, drink soda and don't get regular checkups; but it is your fault if your treatment doesn't last at least five years. If you don't believe me ask your local state board of dental examiners, or go ask a dental malpractice attorney. You have to treatment plan aggressively enough so that the treatment is going to last at least five years. Period.

2. I think the second biggest problem in clinical dentistry is not knowing what you don't know. Like they say, "There are known knowns, there are things we know that we know and there are known unknowns." That is to say, there are things that we know we don't know! You obviously know what you know – coursework during dental school, continuing education courses, performing a lot of clinical dentistry and seeing over time what works and what does not. But there are also unknown unknowns. There are things we don't know that we don't know. Have you ever done a bone graft after an extraction? Have you ever taken on an orthodontic case or perio surgery? Have you ever done a sinus lift or placed a single root form implant? If you've answered NO to all these questions you need to form a very tight team with your local specialists.

The best way to learn more of your unknown unknowns is working with your team of specialists. When was the last time you took a case over to your specialist at lunch or after work to review the pano, FMX, study models, photographs and perio charting? I am absolutely positive that you will learn a lot by doing this. Specialists love to work closely with their referring dentists. Through working together, you might find something as simple as an interproximal lesion that you missed on the bitewings. Sometimes it is something as simple as extracting a tooth on an anxious patient. Other times they blow you away when they complete what you swore to be an impossible implant case due to sinus anatomy or lack of bone. One time I went over a crown lengthening procedure with a periodontist only to learn that the tooth needed to be extracted and replaced with an implant and crown.

To help you learn more of what you don't know, Dentaltown.com has more than 90 free online continuing education courses teaching endo, perio, pedo, prostho, ortho, oral surgery, implants, infection control, practice management, etc. These courses are free and have received outstanding reviews as they have been developed by some of the best speakers in dentistry. More than 200,000 courses have been taken so far. The feedback is so positive, you must check them out.

3. I think the third biggest problem in clinical dentistry is not being up to date on the best technology available to help the outcomes of your cases. How much better can you perform high-quality long-lasting dentistry if you use technologies that allow you to clean out endo canals with 300rpm NiTi's? How much better and high quality is your working length in a root canal if you use instant digital radiography with apex locators?

What dental procedures are you doing that, if you had referred them to a specialist, better technology would have been used? Most periodontists and oral surgeons who place implants have much better radiographs using cone beam computed tomography (CBCT); do you? Just imagine the boost in case acceptances you'd see if you could produce clear-as-day images for your patients through the use of CBCTs and intra-oral cameras that do more than simply explain what needs to be done!
Howard Live

Howard Farran, DDS, MBA, MAGD, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, email colleen@farranmedia.com.

Dr. Farran’s next speaking engagement is February 27, 2009 at the Westin in Chicago, Illinois. For more information, please call the Cal-Lab Group at 336-835-9251.

Seminars 2009
Mar. 20 • Harrisburg, PA
Harrisburg Area Dental Society

Apr. 2 • Las Vegas, NV
Townie Meeting

Apr. 24 • Tulsa, OK
Oklahoma Dental Association

May 8 • St. Louis, MO
Greater St. Louis Dental Society

Oct. 3, 4 • Honolulu, HI
ADA Annual Session

Oct. 31 • Fort Wayne, IN
Mid-west Oral Surgery
4. I think the fourth biggest problem in clinical dentistry is not having the best long-term highly trained staff available. This drastically affects your clinical dentistry from keeping your surgical site clean and visible to using all your dental sundries and products in the right manner. How many crowns come off because the cement wasn't mixed correctly? This is why I like 3M ESPE Rely-X automix dispenser because it dispenses the correct amount of both the catalyst and the base making it almost foolproof. Having a winning team that is highly trained will then make almost any procedure you do foolproof.

Do you take your staff to dental continuing education courses? I have always been amazed at how many dentists show up alone to continuing education courses. When I was earning my MAGD and my DICOI, I would say the average was only one in three dentists who brought their staff with them; this is a huge mistake. My assistant, Jan, has been at my side for more than 20 years and has gone to many continuing education courses with me. I am sure Jan knows as much as I do! I can't even count how many times she has helped me out in a bind whether it be changing the correct instruments quickly when removing a boney, impacted third molar to keeping an implant socket thoroughly flushed so as not to burn bone. Make your dental assistant team top notch and your dentistry will improve greatly.

If you're facing any or all of these problems, you need to know how negatively they can impact your practice. You can overcome these problems if you know your limitations, increase your knowledge base, get more involved with your specialists, utilize the best technology that fits your practice and create the best staff possible. Above all, remember why you became a dentist in the first place! I know, I know, "Easier said than done, Howard," but you'd be surprised at how taking care of the big problems can drastically lessen all of the smaller problems you face each day.
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