Howard Speaks by Howard Farran DDS MBA MAGD

Dr. Wayne Dyer, called the “father of motivation” by his fans says that it is okay to worry about past or future events as long as it does not immobilize you in the present tense. Despite his childhood spent in orphanages and foster homes, Dr. Dyer, author of numerous multi-million-copy bestsellers, including, Your Erroneous Zones, has earned a doctorate in counseling psychotherapy and personally overcome many obstacles to make his dreams come true. Today he spends much of his time showing others how to do the same. His basic philosophy focuses on positive and practical advice for breaking free from the trap of negative thinking and enjoying life to the fullest. Dyer says “If you’re plagued by guilt or worry and find yourself unwittingly falling into the same old self-destructive patterns, then you have “erroneous zones”—whole facets of your approach to life that act as barriers to your success and happiness. If you believe that you have no control over your feelings and reactions, you give up the many choices that are available to you.”

In recent days, I have been particularly impressed with the overall spirit of America and in particular our profession as a whole. Hopefully, we will not allow this progressive solidarity to dissipate and we will take advantage of this momentum to increase communication between general dentists and specialists.

Recently, there was a discussion on our message boards at www.dentaltown.com that revolved around how specialists ‘reward’ family practice dentists for their referrals. After reading the posts, my question still remains what would be adequate compensation? I suggest that we strive to remove the barriers of communication that exist between specialists and general dentists. I believe we should instead work to increase understanding of the challenges each of us face and strive towards a mutually beneficial goal for our patients and our profession.

I’m sure you have seen, as I have in my own practice, patients in their late forties who are fighting to save their teeth. Age and poor oral hygiene routinely bring dental complications that often result in extractions. Let’s discuss for a moment a typical scenario. You, a family practice dentist, are used to placing an average two crowns a day. Mrs. Smilesalot comes into your office, missing a tooth, and wants it replaced. You begin to explain all her options. First of all, you could do nothing for free, a flipper for $395, a super duper flipper with custom clasps for $1250, a 3unit fixed bridge for $2495, or an implant and crown for $2495. You know the next question will be, “Which is better, the bridge or the implant?” You look yourself in the mirror and believe that you explained to her all of her options but whether you are aware of it or not, you tilted the scales in favor of the bridge nine times out of ten. You only have to look at the data to see that general dentists everywhere are still favoring bridges over implants in the vast majority of cases.

So, why is this occurring? Fear of failure and lack of communication between general dentists and dental specialists. This type of behavior is not so hard to understand. It’s really quite basic. You see, even a rat that sticks its tongue in a light socket won’t do it again.

Here’s a typical example of how lack of communication and education can result in fear and intimidation. The patient returns to you, her family practice dentist, after receiving the ‘go ahead’ from her oral surgeon to complete her implant restoration. Your front office has scheduled her for an hour to do an implant crown on #3. You lean her back in your chair and immediately see a healing cap sticking through the gums and now the mental torture begins. The draw is okay but do you know what type of implant was placed? Do you know what pieces you were supposed to have ordered? Do you need a transfer coping or was it an impression analog? Does your implant screw driver fit Branemark, or was it Biohorizons, Noble Biocare, Sterioss, Imtec, 3i, Dentatus, Corevent, Bident, or ITI Strauman! If you call the implant company rep will he degrade every other manufacturer, except for the one he is economically rewarded and not give you an answer? Didn’t the specialist mail or fax something over? Is it in her chart? At this point you realize nothing is going to happen this morning but diagnosing and treatment planning parts and pieces. And now, you’re thinking, ‘damn I wish I would have just done a bridge!’

So, is the bridge really better for her or are you limiting her choices due to little or no communication between the implant specialist and you and the fear factor? There has been too much division between all the specialized segments of dentistry—implantology, periodonists and oral surgeons. I suggest we strive to remove the barriers of communication and aspire to working towards a mutually beneficial goal for our patients and all our colleagues. This is the time to build a stronger sense of community with your family, your community and your colleagues! So call the specialists you use for referrals, meet for lunch, dinner, or golf and brainstorm for a better tomorrow for everyone!

Together we can strengthen and unite our nation and our sovereign profession of dentistry.