"The best and most beautiful things
in the world cannot be seen, nor
touched ...but are felt in the heart."
-- Helen Keller
I was preparing a tooth for a new gold crown during my dental school clinical requirements and felt in the zone. I had carefully sculpted the patient's mouth with the perfect crown preparation in mind, a design as pictured in text books. The taper was barely over six degrees as desired and the maximum amount of tooth structure was preserved. With immense pride and confidence, I was anxiously waiting my clinical instructor to verify my perceived talent.
He looked into my patient's mouth, thoroughly inspecting the tooth with high powered magnification loupes, tilting the mirror in several different angles. At last, he told the patient, "That is the most perfect crown preparation I have seen in years. Dr. Foy has really done you a great service."
My pride and ego soared. I completed the impression and cemented the temporary crown. After my patient left, the instructor came over and said, "That was a nice job. But when you are out in the real world don't expect a standing ovation from your patients. Most people value quickness and lack of pain, not line angles and perfect margins. They will never see or appreciate that type of quality. You’ll have to motivate yourself to continue to maintain it, and break your own arm slapping yourself on the back.”
One of my patients, a maintenance man in his early sixties, had volunteered to go with a group of medical missionaries to the poor areas of Guyana, Africa. Larry had a full head of wavy hair, snow-white with age, and the Guyanese people exalted him as possessing great powers, looking up to him in a godlike manner.
During his stay he met and married a young African woman named Lily. My dental journey with her was one of the most surprising and gratifying of my career.
Our American emphasis on personal esthetics can be extreme to someone from an impoverished country. Larry’s new bride had a hard time adapting. She was extremely self-conscious, but at least she could speak a little English.
As with many immigrants Lily had little or no previous dental care, but she was free of any fillings. First, we treated some gum disease and instructed her on proper oral hygiene techniques. After she mastered a self-care routine, we were able to restore minor decay. In the beginning we were simply trying to build the foundation for cosmetic dental care. Lily was compliant and eager to fix her anterior teeth.
She had grown up in an area of Africa where the water supply was rich with fluoride at a level so extreme that all of the people had severe fluorosis. This condition caused their teeth to take on a reddish-brown color.
When everyone around you has similar teeth you do not stand out, but in America the prominence of white teeth made Lily ashamed of her smile. She covered her mouth when she spoke, and this was crippling her ability to adapt. Larry asked for our help.
After a consultation, Lily decided to cosmetically enhance her smile. Diagnostic casts were made to plan for size, function and space management. Despite all the discussions and pre-planning, it was still difficult for her to completely appreciate and comprehend the result.
The day of final delivery was a day that I will never forget. Local anesthetic was used and Lily was cooperative through out the procedure. When everything was cemented, cleaned and polished, I handed her a mirror. At first, she remained expressionless, and tears began to roll down her face.
I was confused by her reaction. Were these tears of joy, tears of shock or disappointment? I waited nervously for her opinion.
Lily remained stoic as she peered into the mirror. Suddenly her face lit up with a beautiful grin. She leaped out of the chair and started doing a little jig, dancing in circles around the small room. Then she dropped down on her knees and began kissing my feet.
I quickly bent over, grabbing her arms, trying to lift her up, protesting, "No, no, no, no, no...." when Larry walked into the room.
It is odd to have a husband witnessing his wife on her knees kissing your shoes.
Larry laughed, and as Lily jumped up and showed him her new teeth, he exclaimed, "Wow! I cannot believe it." She shrieked and ran into the waiting room, going from chair to chair to show her new smile.
Some things are better than a standing ovation.
Monday, October 26, 2009
Tuesday, October 20, 2009
YOUR CHILD'S TEETH AND ORAL HEALTH
A common question or misunderstanding in dentistry; “When should I bring my child to the dentist.” There is not a specific age, but as a general rule, it is at about one year of age. Prior to one year of age if a parent is concerned about a discoloration on a new erupting tooth or any other unusual findings in the mouth , then a short “look see” would be appropriate to rule out any potential developmental problems. A “look see” is a short exam by the dentist to determine if there are any specific concerns or abnormalities.
In April of 2007 the CDC (the Center for Disease Control) released a Report that for the first time in their recorded history in the USA that the decay rate among children ages 2 to 5 years of age has increased. This is a wake up call for all of us. Therefore, new parents need to implement and maintain oral hygiene habits for their kids as soon as the first tooth erupts. Also, we need to re-look at public health issues in this troubling area of the increased incidence of tooth decay in America.
In a diverse society the message to new parents should be culturally sensitive, so all sectors of the population will have access to the information needed to maintain good health.
As soon as the teeth start to erupt into the mouth it is recommended that parents seek professional advice on how to maintain oral health in their child’s mouth.. The goal is at a minimum to remove all the plague from the teeth at least on a daily basis. Twice a day would be more desirable. This can be accomplished with an infant’s toothbrush, wash cloth or even a piece of gauze. Toothpaste is not necessary at this early age. The sooner your child adapts to you cleaning their teeth for them the better. Young children may resist at first, but this is important battle that each parent must win in order to prevent unwanted tooth decay.
Baby bottle tooth decay is also a common occurrence that can be avoided by taking a few simple steps at or before bedtime. Never put your baby to bed with a bottle containing milk, formula, fruit juices, sodas or any sugary liquids. Even though some of these liquids are needed for proper nourishment they can destroy or decay the teeth if left on the teeth for extended periods while sleeping. Brush the child’s teeth before bedtime and only offer water after the teeth had been cleaned at bedtime.
BY PATRICK J FOY, DDS
In April of 2007 the CDC (the Center for Disease Control) released a Report that for the first time in their recorded history in the USA that the decay rate among children ages 2 to 5 years of age has increased. This is a wake up call for all of us. Therefore, new parents need to implement and maintain oral hygiene habits for their kids as soon as the first tooth erupts. Also, we need to re-look at public health issues in this troubling area of the increased incidence of tooth decay in America.
In a diverse society the message to new parents should be culturally sensitive, so all sectors of the population will have access to the information needed to maintain good health.
As soon as the teeth start to erupt into the mouth it is recommended that parents seek professional advice on how to maintain oral health in their child’s mouth.. The goal is at a minimum to remove all the plague from the teeth at least on a daily basis. Twice a day would be more desirable. This can be accomplished with an infant’s toothbrush, wash cloth or even a piece of gauze. Toothpaste is not necessary at this early age. The sooner your child adapts to you cleaning their teeth for them the better. Young children may resist at first, but this is important battle that each parent must win in order to prevent unwanted tooth decay.
Baby bottle tooth decay is also a common occurrence that can be avoided by taking a few simple steps at or before bedtime. Never put your baby to bed with a bottle containing milk, formula, fruit juices, sodas or any sugary liquids. Even though some of these liquids are needed for proper nourishment they can destroy or decay the teeth if left on the teeth for extended periods while sleeping. Brush the child’s teeth before bedtime and only offer water after the teeth had been cleaned at bedtime.
BY PATRICK J FOY, DDS
Tuesday, October 13, 2009
I WANT TO BE A DENTIST
The secret of joy in work is contained
in one word -- excellence. To know how
to do something well is to enjoy it.
-- Pearl S. Buck
The night I told my dad that I wanted to be a dentist, he shook his head. "Oh shit! You'll grow up to be a Republican."
The smell of the stockyards permeated the close summer night. My father was sitting in his over-stuffed green chair in the TV room, dentures lying bare on the desk, sucking the knuckle of a pickled pig's foot. No person with hearing could stand that sound, but it was time to pound out my career plans.
"You'll be a painter!” Dad barked.
I had not considered for a second that I would take over his paint contracting business. My oldest brother Mike and I had both painted for dad as soon as we became teenagers, but my father was not big on nepotistic privileges.
He gave us the worst jobs. On the roof of a Texas meat-packing plant, we scraped tallow, the caked grease of boiled cows, off the walls in 100-degree heat. We painted flag poles on top of multi-storied buildings, spent a summer puttying the nail holes on the wood trim of 136 condo units, sandblasted the inside metal tanks of air hoods in sauna heat.
I held out my arms representing his whole world. "I don't want to take over your business."
"You little shit, you don’t know what you want!”
“I know I can be better dentist than Doctor P.” He was our family friend. “And you wanted to become a Vet yourself!"
I was playing dirty now because the Great Depression had denied Dad his personal goal of becoming a large-animal veterinarian. At first, I myself wanted to be a vet, but after few months in an animal doctor’s office, I discovered it was not my cup of tea. Being an independent cuss, I decided that dentistry would give me more freedom than medicine.
“I just want the opportunity to do my best."
Dad set the bare knuckle in a bowl next to his useless dentures and began motioning with his hands as if he were washing them clean.
"Go, go and be a goddamn dentist! Become a shit-for-brains Republican! … I will help you any way I can."
Now, after nearly three decades of dentistry, I’ve decided that my father voted for his yesterdays, and whatever the party, I vote for my tomorrows.
-- Patrick J. Foy, DDS
in one word -- excellence. To know how
to do something well is to enjoy it.
-- Pearl S. Buck
The night I told my dad that I wanted to be a dentist, he shook his head. "Oh shit! You'll grow up to be a Republican."
The smell of the stockyards permeated the close summer night. My father was sitting in his over-stuffed green chair in the TV room, dentures lying bare on the desk, sucking the knuckle of a pickled pig's foot. No person with hearing could stand that sound, but it was time to pound out my career plans.
"You'll be a painter!” Dad barked.
I had not considered for a second that I would take over his paint contracting business. My oldest brother Mike and I had both painted for dad as soon as we became teenagers, but my father was not big on nepotistic privileges.
He gave us the worst jobs. On the roof of a Texas meat-packing plant, we scraped tallow, the caked grease of boiled cows, off the walls in 100-degree heat. We painted flag poles on top of multi-storied buildings, spent a summer puttying the nail holes on the wood trim of 136 condo units, sandblasted the inside metal tanks of air hoods in sauna heat.
I held out my arms representing his whole world. "I don't want to take over your business."
"You little shit, you don’t know what you want!”
“I know I can be better dentist than Doctor P.” He was our family friend. “And you wanted to become a Vet yourself!"
I was playing dirty now because the Great Depression had denied Dad his personal goal of becoming a large-animal veterinarian. At first, I myself wanted to be a vet, but after few months in an animal doctor’s office, I discovered it was not my cup of tea. Being an independent cuss, I decided that dentistry would give me more freedom than medicine.
“I just want the opportunity to do my best."
Dad set the bare knuckle in a bowl next to his useless dentures and began motioning with his hands as if he were washing them clean.
"Go, go and be a goddamn dentist! Become a shit-for-brains Republican! … I will help you any way I can."
Now, after nearly three decades of dentistry, I’ve decided that my father voted for his yesterdays, and whatever the party, I vote for my tomorrows.
-- Patrick J. Foy, DDS
WHAT WILL YOU PUT IN YOUR BOX?
“Treasure the love you receive above all. It will survive long after your good health has vanished.”
Og Mandino quotes (American Essayist and Psychologist, 1923-1996)
Joe was a fifty-year-old Iowa optometrist who was diagnosed with an aggressive form of brain cancer. He decided to continue to practice as long as he felt capable, but eventually the tumor would win out.
One cold January day, he drove to work as he had for more than twenty years and began a typical morning. After he had completed a few eye examinations, he was startled to find something subtle had changed in his motor skills. It hit him hard to realize that his health had finally deteriorated to the point where he could no longer work. All the years of education and career challenges suddenly stopped; it was time for him to go.
Without notifying his staff, Joe found a small cardboard box to pack up his belongings. He walked around from room to room searching for the treasures of his life, gathering all the personal items that he wanted to take along. But now the common things that he had used daily took on a new and different value. He was amazed at the simple mementos he collected. The picture of his three daughters when they were toddlers crammed into a wading pool, the fathers day present of a mug that read ”World’s Greatest Dad”, framed pieces of art that one of his daughters painted in grade school, and many other small tokens of love from family and friends that filled the box with twenty years of joy. Not one item in the box had anything to do with his career; everything had to do with the people he loved.
Joe walked to the front desk where his staff standing by and quietly announced, "I'm done.” Then he limped to the door, clutching his precious box, and left work for the last time.
-- Patrick J. Foy, DDS
Og Mandino quotes (American Essayist and Psychologist, 1923-1996)
Joe was a fifty-year-old Iowa optometrist who was diagnosed with an aggressive form of brain cancer. He decided to continue to practice as long as he felt capable, but eventually the tumor would win out.
One cold January day, he drove to work as he had for more than twenty years and began a typical morning. After he had completed a few eye examinations, he was startled to find something subtle had changed in his motor skills. It hit him hard to realize that his health had finally deteriorated to the point where he could no longer work. All the years of education and career challenges suddenly stopped; it was time for him to go.
Without notifying his staff, Joe found a small cardboard box to pack up his belongings. He walked around from room to room searching for the treasures of his life, gathering all the personal items that he wanted to take along. But now the common things that he had used daily took on a new and different value. He was amazed at the simple mementos he collected. The picture of his three daughters when they were toddlers crammed into a wading pool, the fathers day present of a mug that read ”World’s Greatest Dad”, framed pieces of art that one of his daughters painted in grade school, and many other small tokens of love from family and friends that filled the box with twenty years of joy. Not one item in the box had anything to do with his career; everything had to do with the people he loved.
Joe walked to the front desk where his staff standing by and quietly announced, "I'm done.” Then he limped to the door, clutching his precious box, and left work for the last time.
-- Patrick J. Foy, DDS
Monday, October 5, 2009
A Class I Missed In Dental School
Immersed in my private practice of dentistry for 25 years, I was fortunate; things seemed to have been rolling along quite smoothly. Until Jesse came into our practice. Jesse was a very serene, soft-spoken, tall, sleek, ravishing young black woman in her early thirties. Her unassertive manner and gracious attitude always made her visits pleasant and delightful. She had perfect dental health with absolutely no sign of any other health concerns. Her only dental concern was that she had slightly narrow central incisors resulting in a diastema (space) between her front two teeth. The small space in her teeth represented the only minor flaw in her goddess-like physical appearance.
Over the years, I have learned that these small defects that a person dwells on can sear relentlessly on the psyche. It does not matter how insignificant the problem may be; it mercilessly affects his or her perception of self. Jesse’s dream was to have that diastema corrected with dental veneers. She was the one driving her own treatment plan. Her radiant beauty was not affected one iota by her teeth, but it was a mental gremlin to her self-esteem.
After long discussions and reviewing all of her options, I finally caved in to her request to veneer her front two teeth. She was correcting the sole blemish that she perceived in her appearance. The case was one hundred and ten percent successful, and she broadcast her beauty and her confidence instantaneously.
Even though the appearance of her teeth I never discerned as unsightly, she, on the other hand, was so grateful and happy with our expertise that it made our day. Gratitude is hard to deny.
Months went by. Jesse was scheduled for a routine cleaning visit, and she failed to show up for the appointment. That was out of character for her. There was no answer on her apartment phone, so a message regarding her appointment was dictated on her answer machine. A day later her mother called. Jesse, she told our receptionist, would not be coming back. She had died of complications from a bleeding gastric ulcer.
Young, healthy, seductive enchanters are not supposed to die. They never told me in dental school that my patients were going to die.
I was numb by the news of Jesse’s death. My dismay evolved into anger. I was feeling betrayed and ill-prepared for the experience of potentially hundreds of patients dying over the years. The relationships I have enjoyed with people make going to work very gratifying. I feel honored to be part of their lives and feel extremely close to many people. Even though I have experienced many patients dying over the years, Jesse was the unexpected slap in the face that made me appreciate the harsh reality of several deaths.
I was unable to shake the shock of Jesse’s death. It haunted me and forced me to recount my previous experiences with patients dying. The pain caused by a loved one dying played out several times in my dental chair. The variety of emotions expressed after a loss has been enlightening. We as humans grieve in our own ways, and there are not rules of grief or established social norms. Listening to my patients vent, mourn, laugh, cry, celebrate, distress, and share their personal feelings has given me an education that very few are privileged to witness.
Unfortunately, early in my career I was not as adept at managing the correct words for a grieving family. When I purchased my practice, I inherited a family from the previous dentist which included three teenagers. Their mother was going through chemotherapy for breast cancer. I had seen their mother only once before she died as a result of her cancer. Stymied by ignorance and inexperience, I fumbled for words of sympathy, but I still remember feeling awkward and incompetent. It forced me on a journey of a lifetime to be a better human in this most painful time of life.
I developed a healthy curiosity around how families differ in their process of letting loved ones pass. I watched my own family and my wife’s family react in completely different ways. I began to soul-search my own experience with death. I relived my childhood experiences with the death of grandparents and pets. I recounted how relatives, parents, and siblings processed the experience of grieving. Knowing that each family and each person develops his or her own “culture” in this area helped me to accept my own helpless ignorance.
I cannot pretend to know what each person honestly needs or wants at this hard time in life, but acknowledging their loved one is a great start. Also, expressing your thoughts, memories, and sympathy is always appropriate and welcomed by the grieving. Offer your willingness to listen or offer to help in any way possible. This is the least you can do for people you have shared a relationship with over the years.
Shortly after the shock of Jesse’s death had subsided, another of my patients, Jane, came in for a minor dental repair. Jane had lost her 16-year-old son in a motor vehicle accident years before. Her son had been a happy, slightly rebellious, robust, energetic teenager. I remember his great smile and his boyish sense of humor. We had not ever talked about her son, Christian, had not spoken of him for years. It was during the Christmas season, and I realized as a parent that the holidays stimulate many memories of the past. In the spirit of acknowledging Christian’s life, I asked Jane, “How old would Christian be today?”
She lifted her chin and smiled. Her eyes focused on my eyes. There was a peaceful glow that emanated from her face. With joy and gratitude in the tone of her voice, she shared, “Christian would be 35. We really had a lot of fun together. I loved him so much.” There was absolutely pure exuberance and celebration of the opportunity that she shared her life with her son. I received another gift of her insight in return for my inquiry.
All of us hope that we are remembered after we leave this earth. After the tears vanish, the families on my dad’s side immediately start celebrating the life of the deceased. We laugh and tell stories of fond memories that we all enjoyed together. We rehash events of the past that touched our lives in many ways. I remember many funerals where laughter was so prominent that it was hard to imagine sorrow was present.
In this process of soul-searching in the area of death and grieving, I realized that we as dentists experience loss in more ways than just death. Patients and families leave our practices for many reasons, but it still feels like a loss. When a patient leaves our practice, it is a mini-death. That loss is real, and stimulates an emotional response. Understanding how you personalize that sense of loss and the emotions that may surface as a result of that loss is an experience that is unique to each one of us. Therefore it is important to acknowledge and recognize those feelings for the benefit of your long-term mental health. Many emotions of grieving are possible many times through out our careers, among them anger, betrayal, loneliness, depression, and rejection. Grieving is an area that should be addressed as part of our education, but the subject has never been addressed in my entire career.
Many dentists complain that we have not had enough business classes or are not trained to run a dental practice. I contend the emotional void may result in a more harmful result.□
*Dr. Foy is a general dentist in private practice in Minneapolis, Minnesota. E-mail is riversidedental@qwest.net.
Over the years, I have learned that these small defects that a person dwells on can sear relentlessly on the psyche. It does not matter how insignificant the problem may be; it mercilessly affects his or her perception of self. Jesse’s dream was to have that diastema corrected with dental veneers. She was the one driving her own treatment plan. Her radiant beauty was not affected one iota by her teeth, but it was a mental gremlin to her self-esteem.
After long discussions and reviewing all of her options, I finally caved in to her request to veneer her front two teeth. She was correcting the sole blemish that she perceived in her appearance. The case was one hundred and ten percent successful, and she broadcast her beauty and her confidence instantaneously.
Even though the appearance of her teeth I never discerned as unsightly, she, on the other hand, was so grateful and happy with our expertise that it made our day. Gratitude is hard to deny.
Months went by. Jesse was scheduled for a routine cleaning visit, and she failed to show up for the appointment. That was out of character for her. There was no answer on her apartment phone, so a message regarding her appointment was dictated on her answer machine. A day later her mother called. Jesse, she told our receptionist, would not be coming back. She had died of complications from a bleeding gastric ulcer.
Young, healthy, seductive enchanters are not supposed to die. They never told me in dental school that my patients were going to die.
I was numb by the news of Jesse’s death. My dismay evolved into anger. I was feeling betrayed and ill-prepared for the experience of potentially hundreds of patients dying over the years. The relationships I have enjoyed with people make going to work very gratifying. I feel honored to be part of their lives and feel extremely close to many people. Even though I have experienced many patients dying over the years, Jesse was the unexpected slap in the face that made me appreciate the harsh reality of several deaths.
I was unable to shake the shock of Jesse’s death. It haunted me and forced me to recount my previous experiences with patients dying. The pain caused by a loved one dying played out several times in my dental chair. The variety of emotions expressed after a loss has been enlightening. We as humans grieve in our own ways, and there are not rules of grief or established social norms. Listening to my patients vent, mourn, laugh, cry, celebrate, distress, and share their personal feelings has given me an education that very few are privileged to witness.
Unfortunately, early in my career I was not as adept at managing the correct words for a grieving family. When I purchased my practice, I inherited a family from the previous dentist which included three teenagers. Their mother was going through chemotherapy for breast cancer. I had seen their mother only once before she died as a result of her cancer. Stymied by ignorance and inexperience, I fumbled for words of sympathy, but I still remember feeling awkward and incompetent. It forced me on a journey of a lifetime to be a better human in this most painful time of life.
I developed a healthy curiosity around how families differ in their process of letting loved ones pass. I watched my own family and my wife’s family react in completely different ways. I began to soul-search my own experience with death. I relived my childhood experiences with the death of grandparents and pets. I recounted how relatives, parents, and siblings processed the experience of grieving. Knowing that each family and each person develops his or her own “culture” in this area helped me to accept my own helpless ignorance.
I cannot pretend to know what each person honestly needs or wants at this hard time in life, but acknowledging their loved one is a great start. Also, expressing your thoughts, memories, and sympathy is always appropriate and welcomed by the grieving. Offer your willingness to listen or offer to help in any way possible. This is the least you can do for people you have shared a relationship with over the years.
Shortly after the shock of Jesse’s death had subsided, another of my patients, Jane, came in for a minor dental repair. Jane had lost her 16-year-old son in a motor vehicle accident years before. Her son had been a happy, slightly rebellious, robust, energetic teenager. I remember his great smile and his boyish sense of humor. We had not ever talked about her son, Christian, had not spoken of him for years. It was during the Christmas season, and I realized as a parent that the holidays stimulate many memories of the past. In the spirit of acknowledging Christian’s life, I asked Jane, “How old would Christian be today?”
She lifted her chin and smiled. Her eyes focused on my eyes. There was a peaceful glow that emanated from her face. With joy and gratitude in the tone of her voice, she shared, “Christian would be 35. We really had a lot of fun together. I loved him so much.” There was absolutely pure exuberance and celebration of the opportunity that she shared her life with her son. I received another gift of her insight in return for my inquiry.
All of us hope that we are remembered after we leave this earth. After the tears vanish, the families on my dad’s side immediately start celebrating the life of the deceased. We laugh and tell stories of fond memories that we all enjoyed together. We rehash events of the past that touched our lives in many ways. I remember many funerals where laughter was so prominent that it was hard to imagine sorrow was present.
In this process of soul-searching in the area of death and grieving, I realized that we as dentists experience loss in more ways than just death. Patients and families leave our practices for many reasons, but it still feels like a loss. When a patient leaves our practice, it is a mini-death. That loss is real, and stimulates an emotional response. Understanding how you personalize that sense of loss and the emotions that may surface as a result of that loss is an experience that is unique to each one of us. Therefore it is important to acknowledge and recognize those feelings for the benefit of your long-term mental health. Many emotions of grieving are possible many times through out our careers, among them anger, betrayal, loneliness, depression, and rejection. Grieving is an area that should be addressed as part of our education, but the subject has never been addressed in my entire career.
Many dentists complain that we have not had enough business classes or are not trained to run a dental practice. I contend the emotional void may result in a more harmful result.□
*Dr. Foy is a general dentist in private practice in Minneapolis, Minnesota. E-mail is riversidedental@qwest.net.
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