Robert S. Minch, D.D.S., P.A.

I remember my first camera but I won’t tell you just how many years ago it was that I got it. I think it was called a Kodak Instamatic and it had the plastic flash cubes that went on top of the thin rectangular camera and pivoted 45 degrees after of its 4 flashes. The pictures were grainy and small but always told a story- whether it was my first airplane ride to visit my best friend’s grandparent’s farm near Madison Wisconsin in 7^th grade or trying to surprise my older sisters in awkward positions just to be annoying.

Well I have come a long way from that annoying 9 year old (debatable perhaps) and my cameras have kept pace with the time gone by. I went digital in 2001 and embarked on documenting every patient in my dental practice with a photographic series. The series of pictures were always the same- close ups of the smile from different angles and then views of the teeth with the lips retracted so that all the teeth would be visible including mirror shots that show the tops of the teeth. If you have been a recipient of one of these picture sessions (and if you are a current patient odds are you have been) you know that this whole series takes less than 5 minutes and there’s nothing like pulling your lips and cheeks out with retractors while my assistant cracks jokes and I click away.

The question always arises why these pictures are necessary- and it is not 9 year old residual behavior! The truth is that there are several uses for these pictures that make them just as invaluable as the xrays I take during a Complete Exam. Firstly, it gives you, the patient, a chance to see your teeth and smile from angles you can’t normally view as in a mirror. You’d be surprised how different your smile appears from the side-  a view the whole world gets other than you. Another value of these pictures is that when I show them to you on my computer screen, you see what I see. In other words, I could tell you about the fracture lines around a large old silver filling and the dangers of that tooth breaking, but actually seeing those fracture lines is a lot more eye opening. It allows us to truly work together in creating a treatment plan for your mouth by going tooth by tooth, identifying the weak areas and discussing possible options of treatment.

Lastly, these pictures have been a tremendous value in documenting the state of your dental health at a particular point and time- a snapshot if you will. I can’t tell you how many times I have retrieved pictures from 5 years ago and compared them to that same patient’s teeth today- have the teeth changed color? Worn down? Gums receded? Actually moved? Valuable information indeed. Add to that taking pictures for lab communication (so that the lab can see the shade of your teeth in order to create the same shade for a front tooth veneer) and consulting with specialists (maybe eliminating a need for you to travel to a specialist’s office because he was able to give an answer based on a few pictures) and you begin to see just how beneficial and valuable the art of photography can be.

Well last week we found a new and very fun use – portrait photography. I sponsored a course out of my office, which is to say that I brought a dental photography expert from Chicago to the office and along with 5 of my local colleagues, learned techniques for taking studio portraits. I emptied out a rarely used operatory and outfitted it with several softboxes and other equipment that allow me to take professional quality portraits. Edie, my assistant and Corinne, my hygienist were good sports in letting us use them as models as well as Mary, an awesome patient on whom we have recently finished a cosmetic makeover. What I learned is that this can be a very fun, energizing experience that yields amazingly cool pictures. But what I also learned is that there are a multitude of uses for this kind of photography. It is a great way to more accurately document a patient’s full face and smile using softer light, light that is more akin to the way they are seen in social situations. It can be a better indicator of genuine lip position in a patient’s smile since it is out of the dental chair environment and can also give a lab more smile information while they create new front teeth.

And yes, it is a great way to celebrate a whole new look that can be achieved with Complete Dentistry. So if you hear some laughing and hear beeps from the flash units and see flashes coming from the room next to you while you are getting your teeth cleaned, it just may be another celebration of a very happy patient with a beautiful new smile. Pop your head in- we might catch you in an awkward position…..meanwhile, I’m going to see if I can dig up that old Instamatic, just for kicks.

So there I was this morning, bounding into work at 6:30AM – my usual time to come in is closer to 5:30 AM to go over paperwork, catch up on lab work and to make sure that all is in order for this day’s group of patients. Today I was an hour later because I stopped at the gym first for a quick workout – I am leaving for Scottsdale, AZ this afternoon so I wanted to hit the gym before I left. My schedule is a little quirky but that’s a subject for another blog piece on another day.

Anyway, as I reviewed this morning’s schedule I saw that Heather was my first patient. Heather has been a patient of mine for over a year and she has been slowly working towards getting her mouth healthy. We were scheduled today to bond a porcelain onlay onto one of her back teeth. The truth is, all of her back teeth need the protection that onlays/ crowns provide but there are several barriers to completing the ideal treatment. First and foremost, Complete Dentistry can be expensive- an investment really because you pay now in order to not have to pay more later. But, in Heather’s case (and truthfully, many of my patient’s case) the work needs to be phased over several years because of limited finances. Heather is a 34 year old single mother- although she would want me to quickly say that she thinks of herself as being 23! Her daughter Abbey is 15 so fixing teeth falls down the priority list somewhat.

But, as daunting as affording ideal dentistry can be, Heather’s bigger issue is that she is just plain scared of having dental work done. I remember very clearly our first appointment together. We had just finished the Complete Exam which, in her case, included a full series of xrays ; during the consultation appointment,  we went over the xrays and digital pictures, tooth by tooth, and I began to point out the many teeth that were in need of attention due to large cavities and fillings that were falling apart. That was when she started crying…..not a totally unusual reaction because when a patient finds out that their teeth are decaying and may need to come out, it can be a very emotional moment. For Heather, the news was even more devastating because, she had just moved here from Virgina where she had recently finished “fixing her teeth” with what she thought was going to be high quality dentistry (a root canal, crown and many fillings….)that were now decayed and in need of refilling and possibly more root canals/ crowns….you get the point.

So, to sum up, she had spent over $3000. for dental work that was unpleasant to go through and that was now, only 6 months later, falling apart. Heather was visibly miserable and talked about how she felt that, in most interactions in her life,  she always got the short end of the stick; and that this was just another example. I tried to reassure her and to underscore that we would get her teeth and mouth back to health on a schedule that would work in her life circumstances. She seemed appreciative but very wary at the same time. Gaining her trust was going to be a process.

We started off with several long appointments in order to address the teeth most in need, removing the decay and putting in large fillings that would hopefully hold until we could perform more definitive dentistry on them, possibly several years down the road. Luckily, we were able to avoid root canals and save all her teeth. But, what struck me at these initial appointments was how nervous and apprehensive Heather was. She would take a little medication before the appointment (not at all unusual for dental phobic patients) and would crank her IPOD up to drown out the drilling noise. Her demeanor was very quiet and tense throughout the appointment. We repeated this pattern for several months, but slowly, I could tell that she was starting to relax, the music wasn’t quite so loud and she didn’t have it on so often and ,every once in awhile, a smile would betray her newfound relaxed attitude.

Well that was a year ago and today we were scheduled to finish another round of our carefully designed treatment plan. What struck me when she walked in was how relaxed and funny she was. I casually asked if she had taken any medication before the appointment and she said ”Nope!- don’t need it”. I gave her some anesthesia (where she didn’t even bat an eyelash) and while we were waiting for it to take effect, I remarked how I should write a Blog piece on her transformation. “Oh you should!” she exclaimed “and make sure to write that I have committed to losing 40 pounds, quit smoking and become the hottie I was 15 years ago! And while you’re at it, put that I think that you are the best dentist…the gentlest dentalist!” I had never heard of that term before and Heather agreed that she probably just invented it but I like it!

But what I like even more is the transformation that I have seen Heather make over the past year. I love my job because I love to solve problems and fix things like broken down teeth, uncomfortable bites and ugly front teeth. But what is especially gratifying is to be able to change a patient’s apprehension and sour view of dentistry and convert them into fun, appreciative “family members”. It truly underscores how strongly we (my assistant Edie, receptionist Cindy and hygienist Corinne) believe in our tag line “Creating Relationships, One Smile At A Time”. Or as Heather might say, we are the office of the “gentlest dentalist”!

First of all, my dental assistant, Edie, who has been my right AND left arm for 23 years, has told me that my Blog articles are too long; so here goes a short and sweet observation.

Mary is just a delightful patient who has a very demanding job and , as a consequence, grinds and clenches like nobody’s business. She had her mouth restored, cosmetically, 10 years ago and has loved the result. However, when she came to see me last week, her teeth on the right side of her mouth were throbbing and keeping her up at night. After some xrays and an exam, it was apparent that several of her back teeth, both upper and lower, were in trouble. These teeth were showing the effects of excessive force and several root canals were indicated.

But how did this happen in the first place? After all, her mouth had been restored and the result pleased both her and her dentist. The answer became evident by evaluating her bite and grinding patterns. Due to the way that her teeth naturally come together, there is literally no contact on many of her teeth on the left side. Combine this environment with a heavy clencher and you have a recipe for trouble.

And this, after all, is what Complete Dentistry is about- restoring teeth to health in an environment of healthy gums and bite. In other words, restoring the teeth without accounting for the bite and gums is doing only half of the job. Sure, the teeth may look great when they are restored, but if the other factors aren’t accounted for, the work will ultimately fail due to extreme forces or periodontal disease. With Complete Dentistry, the patient can be assured that the investment in his/her teeth will pay off in terms of minimal maintenance and a comfortable, attractive smile for many years.

As for Mary, she is much more comfortable. She had 2 root canals to treat the affected teeth and is now having porcelain onlays made to add/restore biting surfaces on the left back teeth so that her bite will be even and the clenching forces equally distributed among all her teeth. If only we could get her to downshift from her demanding job to selling pottery in Colorado……

How’s that for short and sweet, Edie?

So there I was in my accountant’s office, several years ago, and he was doing his “accountant thing”- going over my expenses and explaining to me (once again) what “depreciation” means. My eyes start to glaze over just like my patient’s eyes do when I expound on how the TMJ works and how it affects the bite. On this particular occasion though, my accountant finished his explanation and then proceeded to tell me how his dentist tried to “sell” him some porcelain veneers. Needless to say, he wasn’t interested in getting porcelain veneers but I commented that his dentist must not have done a good job explaining why they might be beneficial for his teeth/mouth. To explain the benefits/ risks/ contraindications as well as to project the risks of doing no treatment would be educating him, the patient, so that he could make an informed decision. Whether it is true or not, anything less than that leaves the feeling that one is being “sold”.

I thought about this episode last week when I had Jim,a great patient of mine for 25 years, in the chair. He had come in as an emergency because a piece of his front tooth chipped and he wanted to know the best way to fix it. Now, in truth, the chipped tooth could have been repaired by either a tooth colored bonded restoration or a porcelain veneer. And the other front tooth was worn, discolored and could have benefited from a veneer as well. In fact, the 2 veneers would have given him a much more attractive smile. But ultimately, this was not my decision- it’s the patient’s. So we discussed the pros and cons of each treatment as well as their respective costs. The porcelain veneers would be much stronger, last longer and would not stain over time- as I always like to say, the first veneer I ever did was 23 years ago and it’s still going strong! The bonded restoration, however, is substantially less expensive and less chair time.

After several minutes of discussion, Jim was still undecided but leaning towards the veneers because Edie, my assistant, and I were so excited about them. But I’d rather not have a patient follow through on any major treatment solely on my recommendation. It is much better if the patient makes the decision for himself based on all the facts. So I suggested that we do a “mock up” of the 2 veneers in the mouth so that Jim could get an idea of what kind of difference it would make. This is an exercise where I use bonding material on his 2 front teeth (without using the actual bonding agent so that I can remove the material immediately) and in the space of 5 minutes he can get a real sense of what veneers might look like- think of it as a dress rehearsal.

So in Jim’s case, I fashioned new front teeth and it looked amazing!! I made them a little longer and straighter so that he and his smile looked 10 years younger. After I sat him up and he looked for several minutes, he was still going back and forth over which way to go. He repeated the differences between the veneers and the bonded restoration as he saw them- 1.veneers were stronger and would last longer; 2. The bonded restoration might stain over time and 3.The veneers were more expensive.

What struck me was the benefit that Jim had not mentioned- he neglected to say that the veneers looked better than the bonded restoration, which for me was the primary benefit of the veneers. Jim’s priority was longevity and cost, not superior aesthetics, so , for him, the bonding was the best choice. I was disappointed because I felt that veneers would make a nice improvement in his smile but, ultimately, it’s his mouth and his decision. So we repaired the one tooth with bonding material (which looked awesome!) and he left happy to have had his tooth “fixed” and satisfied that he had been listened to and understood.

So next time your dentist tells you “need” a certain treatment, ask yourself- “Am I being given information to make an informed decision or is this guy/gal/person trying to sell me something”. And while we’re at it, if you understand the concept of depreciation, could you please explain it to me!!