CERAMIC CROWNS ON SECOND MOLARS

What is this a photo of?

Something I see far too often lately! This is a broken ceramic crown on a patient’s lower left second molar. It fractured in two, and the half on the tongue side of the molar is still hanging on. The patient thinks she had the crown placed about eight years ago.

Why did this happen?
The human jaw is a lever system configured like a nutcracker. Your muscles can generate about four times the force in the second molar area than can be generated on your incisor teeth in front. Some patients grind and clench their teeth. It is no coincidence that most fractures of teeth occur on second molars.

The emphasis on esthetics nowadays is so powerful that some patients think I am crazy when I tell them second molars are not the place for ceramic crowns. They either break like this one did, or repeatedly come uncemented. If you have to drill a hole through a ceramic crown to do a root canal, good luck to you. It is a tough job. Can you imagine drilling a hole through a porcelain dinner plate?

Computer-milled zirconia crowns were invented almost twenty years ago. Like most new products, their advantages were exaggerated. They were tougher than traditional porcelain crowns with a metal substructure, it is true. But they were NOT unbreakable, as was claimed. It was advertised that they could be made as thin as half a millimeter, like metal crowns, and still resist fracture. That turned out to be a lie.

Two other disadvantages of milled zirconia crowns: they are so inert that cement often does not bond well to them, and they are so hard that they often wear the natural tooth above or below them.

When I tell patients these facts, the response is often, “Why didn’t my former dentist give me other options?”

The reason is that computer-milled zirconia crowns are currently the cheapest ones available from dental labs. Low cost drives their popularity with dentists and patients alike. But how much does a patient save if a ceramic crown breaks in a few years and has to be replaced at additional expense?

What are the alternatives to ceramic crowns?
They may not be white, but I have never in my career seen a cast metal crown break in two. For nearly a century, metal crowns, particularly ones made of gold alloys, were seen as the standard of care for posterior teeth. They are the crowns dentists themselves most often have in their own mouths!

Nowadays gold is considerably more expensive, but we often make crowns out of more economical alloys like silver-palladium and chrome-cobalt alloys, and they are just as durable.

In the old days when gold crowns were the norm, teeth were cut down far more conservatively, and as a result, fewer teeth needed root canals. Gold crowns occasionally wore through on the chewing surface, but that could be repaired. A fractured ceramic crown cannot be salvaged!

As I tell patients every day, durability needs to be factored into patient choices in dental treatment. Especially in high force areas like the second molar region, it is hard to beat cast metal crowns. Sometimes the tried-and-true methods of doing things are still the best way!

Kim Henry, DMD
December 5, 2023

TWO PATIENTS LOSE MONEY TRYING TO SAVE MONEY

It is hard to resist a “deal” that will save you a sizeable amount of money, isn’t it? Nobody wants to pay more than they should for something. So many times, we see patients leave our practice for “great deals” elsewhere, and they end up paying a hefty price for it. Here are two recent examples that I encountered in one week, plus one disaster yet to happen. Naturally, I am not using real patient names in the stories.

Lucia

Lucia had lived a good part of her life in Peru. There are some good dentists in Peru, but there are also plenty of bad ones, and even assistants practicing as dentists with forged degrees and licenses. Lucia’s Peruvian root canals were poorly done. We were able to redo some of them, but she lost one tooth. Two long lower fixed bridges connected to wisdom teeth in the back had also been done in Peru. Even if the bridges weren’t overly long this would not have been a good idea. As usually happens, the porcelain was cracking off, and the bridges came loose from the wisdom teeth, causing decay underneath.

I told Lucia the span was too great for fixed bridges, and she either had to resort to a removable partial or implants. She did not want anything removable, and believed she could not afford implants.

Lucia’s husband found what he thought was a good dentist in Mexico that would fix the problem at lower cost. Maria returned to my office with two new fixed bridges attached to the wisdom teeth- just like the ones that failed before. The porcelain is already cracking. The bridges were excessively contoured, making her gums recede. Without a doubt, Lucia will eventually lose both new bridges. Her money was completely wasted by ignoring my advice.

Gina

We saw Gina a couple of years back. She had an upper premolar that could not be saved, and we had to extract it. We warned Gina that if she waited, a premolar on the left would start hurting, and soon need a root canal. Gina waited until the tooth hurt. (Why do humans procrastinate?) But instead of coming to me, she decided to go to a dentist that supposedly offered heavily discounted fees.

That dentist did a root canal and a crown on Gina. It went alright for a while, until the whole thing cracked off at the gumline. The reason Gina was given such a low price is the dentist left out an essential part of treatment- a cast post to strengthen the root against fracture. Without a post, the inevitable happened. I am guessing even at the discounted price, Gina probably paid at least $1800 for this failed treatment.

But if it were just the money she lost, it would be bad enough. Gina waited so long to come to me after the fracture that bacteria reinfected the root canal, and Gina lost the tooth. She was out all the money she paid for the root canal and crown, the money I charged for extraction PLUS she has another toothless space in her smile!

And today…#3

Sabrina

Last month I worked up a case on Sabrina where her teeth would be moved by an orthodontist, assisted by implants placed in strategic positions to act as anchors for the braces. This case will require a high degree of cooperation between myself and the orthodontist. There are only a few orthodontists I would trust with a case like this. Sabrina was referred to one nearby.

What did Sabrina do? She checked her insurance list and instead went to a “participating” orthodontist in a corporate clinic. This orthodontist never contacted me, despite requests to do that. He is supposed to be putting on brackets today, as I write this. We have not decided where the implants should go, nor planned anything about the case. Corporate dentists like this guy don’t have time to consult with general dentists. They are typically bonused to start new cases, and they don’t want any consults to slow that process down. Will the case end in calamity? I hope not, but I am not optimistic.

It is hard to comparison shop for dental treatment. The price of procedures is only a minor part of the equation. More important is what procedures you will be billed for, whether they are appropriate, and how competently they are done. Internet reviews can be doctored, and there is no Consumer’s Report on dentists. In the end, competency and honesty of the dentist matters more than fees for procedures. You really do not save any money on a procedure at a cheap price if the procedure is inappropriate, or fails!

July 30, 2023

OUR ADOPTION OF 3D X-RAY

Admittedly, our practice has been slow to adopt digital x-rays. Our fast analog film and top-of-the-line x-ray machines have always minimized patient dose and maximized image quality on traditional film. The hard digital x-ray sensors many dentists put in patients’ mouths are uncomfortable, expensive, and break fairly easily. Since they can’t be sterilized, they must be wrapped in plastic sheaths.

We are never the first to adopt new technologies. One reason is the high price when a new product is first introduced. Any new technology eventually becomes a lot cheaper and better as time goes on, as those of us old enough to remember the cost of the first personal computers know! Some new technologies turn out to be duds that do not perform to expectations. Our strategy is to let others waste money on expensive product failures, while we benefit from the tough lessons they learned.

Here is our new Planmeca 3D x-ray machine, replacing our trusty analog machine of 1991.

It was apparent to me a long time ago that digital x-ray machines with no sensors in the mouth represented the future of dental imaging. We recently skipped over this transient 2D stage to go directly to 3D radiology. These advanced machines produce a miniature CAT scan called “cone beam” radiography. My x-ray model also has the capability of taking side views of the skull that we need for orthodontic cases.

I spend enormous amounts of time in comparing products before purchasing any expensive piece of equipment. In the end, we bought a Planmeca machine. This company’s products have quite a track record. Many institutions, including my dental school, the Veteran’s Administration, and hospital clinics own them. Planmeca offers many superior features, most notably an ultra-low dose setting that still gives good image quality.

Formerly, patients needing cone beam scans for implants or root canal failures would have to go to a specialist or have a van with an x-ray machine come to their house or workplace. Although convenient, this tended to cost more. Now such 3D scans can be done in our office at lower expense.

On a selfish note, after 35+ years of tracing orthodontic skull profiles with pencil, protractor, and acetate sheets at home on weekends, I can finally do it quickly on computer at the office.

Since my graduation in 1980 there have been a few really significant advancements in dental treatment. The first would have to be the success and standardization of implant therapy. The second, in my opinion, is 3D x-ray imaging. Just as medical CAT scans and MRIs antiquated exploratory surgery for diagnosis, the dental cone beam scans make dental diagnosis a lot more accurate and treatment more predictable. Often, a 3D scan will find problems neither the patient nor dentist even suspected!

Patients will enjoy looking through scans of the lower half of their heads on the computer screen. In addition to teeth and the bone that holds them, you may see aberrations of your sinuses and even blockages behind the nose. 3D scans are helpful in analyzing the airway in sleep apnea. We have already diagnosed a grossly enlarged jaw joint in one patient with a history of TMJ dysfunction. Cone beam x-ray machines like mine garner the same information on a smaller part of the body, with much less radiation and a lot less cost than CAT scans at hospitals and imaging centers.

Kim Henry DMD

Medicare to the Rescue for Senior Dental Care?

Senior citizens are excited! Most lose their dental benefits coverage when they retire from their job. After that they are on their own paying out of pocket for necessary dental treatment. Quite frankly, this can cost quite a bit of disposable income for retirees if big-ticket services like crowns or implants are needed.

Now some politicians are promising that dental as well as vision benefits will be added to Medicare. It is not clear how these new benefits will be paid or financed. It seems improbable that government could retroactively increase Medicare deductions on a lifetime of earnings. Barring that, I guess politicians will promise that rich people will be taxed to pay for the new benefits.

Let us take a step back and look at medical reimbursements under Medicare. Despite inflation, they have not been increased in years. Congress actually has to take periodic action to keep Medicare fees from automatically being reduced! Not many GPs or internists want new Medicare patients because government fees are set so low that treating seniors is a money-losing proposition. The Greenspan commission concluded many years ago that Medicare would run out of money before Social Security does, and its predictions are now coming true.

Did you know that even if physicians opt out of participating in Medicare, they can only charge 10% more than the government-fixed low Medicare fee? Medicare is unlike every other private medical insurance policy in this regard. Physicians receive very little for treating Medicare patients. At the last visit, my personal physician said he would only receive $18.34 for my routine office visit. (That is why I usually give him a generous cash tip to continue treating me.)

Do you really think that any Medical dental benefits plan would pay a reasonable amount to dentists for performing treatment, when Medicare is already tottering on insolvency? No, any Medicare dental plan will pay low fees comparable to the lousy medical fees currently paid to physicians.

What kind of dentists will sign up to treat patients on Medicare dental plans?

It will certainly be the usual suspects – high volume corporate dental clinics which play fast and loose with billing procedures. In other words, crooks. Shady billing is almost a necessity to turn a profit treating Medicare patients in medical offices, and the same will be true for dental offices. The only providers likely to work in such clinics will be desperate, inexperienced recent dental school grads.

Any new benefit offered by the government to voters is likely to be very high in promises, and very low in quality. This is especially true with the enormous budget deficits incurred after the COVID-19 pandemic.  As enticing as Medicare dental benefits may sound, patients will likely be very disappointed with the final outcome. Dentistry is a very high overhead profession, and there is no way legislators are going to change that by signing an expansion of Medicare into law. In fact, government regulations are to a large part responsible for the present high cost of dental care.

Kim Henry DMD

October 21^st, 2021

THE INTERNET – A BETTER SOURCE OF HEALTH INFORMATION OR DISINFORMATION?

A fellow member of my church choir cornered me before Wednesday practice. “Dr. Henry, I need your professional advice. I have been doing some research…”

My blood ran cold when I heard those last words. Had this woman

• Been doing controlled experiments in a lab?
• Conducting longitudinal studies on outcomes of patient treatment?
• Been reviewing conclusions of carefully controlled clinical studies published in peer-reviewed scientific journals?

Alas, no! She had been reading junk on the internet.

To make a long story short, the woman had gum recession. A competent local dentist had recommended the standard treatment these days – a connective tissue graft from a donor site in the roof of the mouth. She was scared of this procedure, and wanted to avoid it, despite the procedure’s reliability and proven efficacy. So she searched the internet until she found someone who claimed they could achieve the same result by drawing blood, centrifuging it, and injecting the contents under her gums. That was all the “proof” this woman needed. Now she only had to find a dentist (she was hoping me) to perform the miracle cure she had “discovered.” No dentist she contacted does it that way. (Gee, I wonder why?)

Human beings can be such funny animals. It gives them great pleasure to think they have discovered a “secret” truth that few seem to know about. It makes them feel very powerful- even if the hidden “knowledge” is in fact rubbish. They want to share their “discovery” with the world!

The internet is a wonderful tool, but there are no “qualifiers” for posting information. If you are a high school dropout but want to author a blog about particle physics, go for it! All you need is internet access and a webpage somewhere. In the old days, you had to find a publisher to distribute false information. That was not always easy. Oh, sure, there were always a few self-published paperbacks. Now anyone can disseminate pure nonsense for no cost. If they are lucky, it will go viral and the author will have thousands of adherents to any old crank idea.

• Want to find out how fluoridated water is a secret plot by some cabal to stupefy the population? You can learn all about it on the internet.
• Want to discover how root canals slowly damage all the organs in our bodies? It is out there on the internet.
• Want to know how childhood vaccines cause autism? Just consult an internet “expert” on the subject.

Why do we encounter so much ridiculous misinformation in cyberspace? I can think of several reasons.

1. There is a lot of untreated paranoid schizophrenia out there. It has finally found a convenient public forum.
2. A certain segment of the population feels their intelligence is not appreciated by other humans. The best way to attract adulation is become a guru of unorthodox beliefs which attract a large following.
3. Finally, and most importantly, there is frequently big money to be made in bamboozling fellow humans. After the misinformation usually comes the “hook” that lands the suckers and their money.

The most common “hooks” are supplements and quack therapy. I once saw hippopotamus meat (at great cost) advocated to help “detoxify” the body after silver amalgam fillings were removed. Big money was made by the inventor of the “Cavitat” machine and the surgeons who use it to remove “cavitations” from the jaws that root canals supposedly caused. Quite often these quacks make substantial money teaching classes about such things and by “credentialing” paying students to treat the so-called “malady.”

One thing most people do not realize about the healing professions: we have no “secrets.” If a new technique is discovered to help patients, it cannot be patented. When a new treatment is discovered, our duty is to:

1. Verify the safety and efficacy of the treatment by carefully constructed clinical trials involving other health care providers.
2. Then publish the clinical results so other healers will learn and implement the new technique. Our ultimate goal is always to help patients.

If new equipment is needed for a new procedure, the equipment can be patented and sold for a profit. But not the treatment technique itself.

Getting back to my fellow choir member, a dentist may indeed have tried spinning down blood and implanting the fibrin and cellular components under the gums. It may have seemed to have worked for him a few times. But the technique should be compared in scientific studies to conventional treatment like tissue grafts. Only then will be truth be known. After all, the treatment benefit may diminish over time! But such internet gurus rarely want this. Their bubble might be burst by valid clinical trials.

Charlatans know that they can attract a certain number of patients with paranoid tendencies and normal fear of invasive surgical procedures. Providing unproven, or even quack treatment can be a very lucrative way of earning a living- presenting oneself as a “savior” endowed with “hidden information” that will heal people.

Please be very careful about believing health information you read on the internet, unless it is published by verified and credible authorities. Lately the most outrageous quacks are claiming the title “biologic dentists.” Immediately doubt any information coming from bloggers describing themselves in that manner. Not everyone who has a website can be believed. Not everyone posts internet articles for altruistic reasons like I do!

Dr. Kim Henry
September 2, 2019

 

About the Author:

Dr. Kim Henry practices general and family dentistry in his privately owned practice in Hapeville, Georgia, close to his childhood home.  Dr. Henry provides his patients with dental care to help them keep their natural teeth for a lifetime.  Visit our web site, kimhenrydental.com to learn more about our practice.

AVOIDING OVERT OVERTREATMENT

A couple of years ago, a young college student came to our office, clearly distraught. He never had a cavity in his life. While at college, he decided to go to a corporate chain clinic for the free exam and x-rays advertised on TV. Until then he had been going home to his old family dentist. Thirteen cavities were diagnosed by the corporate clinic, with the recommendation of white plastic fillings for all the teeth. I don’t know why, but he ended up in our office for a second opinion. Since he could not obtain a copy of the x-ray series from the chain clinic, I took a very clear set of my own, and looked over them carefully under magnification. The boy had not one cavity in his mouth! He needed nothing but a routine cleaning.

A while back a patient came to us after visiting a large corporate-owned clinic near Washington DC. He had landed a high-paying contract job in the Middle East, and had to get a dental clearance to secure the job. He brought the corporate clinic’s treatment plan with him. It included a series of deep cleaning appointments, fillings and even a crown or two. I examined his mouth carefully, referring to the x-rays taken at this clinic. The verdict? I could find nothing this man needed except a routine cleaning. I guess the corporate clinic operators thought they really had him over a barrel, since he was under a deadline to get dental clearance for the high-paying job.

Just a couple of weeks ago, a young social worker came to our office after visiting a large Atlanta corporate clinic that advertises a lot via radio. This bright young lady already had a Master’s degree and was starting to work on her doctorate. She had beautiful teeth, and had never had a cavity in her life. Yet the clinic had planned her for four quadrants of root planing and EIGHT white plastic fillings. Fortunately, she was suspicious, and sought our opinion before proceeding with the treatment. We found that she had some tartar under her gums, but really needed only a routine cleaning, and no fillings at all.

Because all three of these patients were skeptical, their teeth were saved from unnecessary, even harmful treatment.

The sad part about overtreatment is not just the money patients spend needlessly. It is the damage to the teeth. Virgin teeth without fillings are a beautiful thing. They are durable and decay resistant. It is one thing to remove a real cavity and put a long-lasting filling where the decay was. It is quite another thing to drill on a tooth free of decay and place a plastic filling that will leak and require replacement in a few years. Every time a tooth is drilled upon, the pulp inside is irritated. With enough treatment, teeth often need root canals and crowns. It often becomes a merry-go-round of one treatment after the other.

Why is inappropriate treatment so common at clinics owned by corporate investors, instead of licensed dentists? Well, for starters, these clinics are usually staffed by young dentists with outlandish student loan debt- often a quarter to a third of a million dollars. The clinics pay them a fairly low commission, and contract with insurance companies to do dental procedures at low fees. This makes it very difficult for young dentist-employees to honestly make a living supporting their families AND pay back their student loans.

Meanwhile, corporate investors who own the clinics typically seek a 20% return on investment. Overhead for dental offices is quite high and 20% profit is hard to achieve, if all staff is paid market wages. Many times, clinic managers (who are not dentists) badger the providers to churn out more dental treatment. A lot is necessary to be scheduled when clinics cut fees 20-30% for insurance companies! Under this pressure, a lot of needless treatment is recommended to patients. At some corporate clinics, dental assistants and office managers actually add treatment so that they can meet the monthly office revenue goals and receive their bonus!

In my experience, overtreatment of patients is fairly rare by independent dentists who own their practices. Dentists like me depend on referrals of new patients by satisfied existing patients, rather than by expensive advertising on radio and TV. To be sure, there may be differences in treatment options presented between honest dentists. Other dentists are far more apt to cut teeth down teeth for porcelain crowns than I am, because the Navy taught me to do do such good silver fillings. Other dentists might be more apt to do bridges on natural teeth rather than implants. These are legitimate treatment differences between dentists. It is a far cry from the blatant fraud perpetrated on patients who have nothing wrong in their mouths!

It is very difficult for the average patient to process what is truthful and what is not in advertising. A good rule is not to believe any advertisements by health professionals broadcast over the airwaves. The promise of free exams and x-rays in a large clinic with expanded late and weekend hours is very tempting, especially to uninsured patients. But judging from patients we encounter, the ultimate cost of letting corporate-owned clinics treat you is very high. You will pay very dearly for that free or discounted exam. After your insurance money is spent, you might have to pay for the treatment out of pocket when something goes wrong!

Incidentally, did you know that ownership of dental offices by corporate investors who are not dentists is actually illegal in Georgia, as well as most other states? Exactly because regulators were afraid of what is presently happening to patients in corporate clinics. How then do all these corporate clinics exist? Corporate investor-owners scam the state regulators by setting a “fake owner dentist” up with a shell corporation, and claim they just “manage” the clinic for the dentist. When in actuality, the official “owner” dentist cannot even access any checking account where funds are deposited from patient payment! Write your Georgia legislature and demand the Georgia Board of Dentistry develop ownership tests, so corporate investors cannot get away with these scams!

THE POWER OF GOLD In Saving Teeth for Life

When I suggest a patient have a gold crown or filling, even in the last molars, the responses are comical and predictable these days. “You think I want to look like a rapper?” is the most common answer I get.

Gold dental treatment was not always regarded with such suspicion by the public. Hundreds of years after the first use of gold for filling teeth, you might be surprised to learn that gold is still considered the longest lasting material ever invented for fillings and crowns! It was taught as the “premium option” when I attended dental school in the late 1970s.  Even our modern plastic polymers and exotic ceramics cannot compare to the longevity of gold when properly used in the mouth. If you look in the mouths of most US dentists (including mine), gold is the most common material you will see!

A filling of pure gold compressed in an upper first molar, beside a silver amalgam filling in an adjacent molar. The gold filling was 77 years old at this writing, and the silver filling in excess of 40 years old. White resin fillings just don’t last this long

Why is gold so durable in teeth?  Well, we know that gold is a very noble metal, meaning it does not combine with other elements like oxygen. Gold placed in a Pharaoh’s tomb 3000 years ago and uncovered will look pretty much like it did the day it was put there.  The mouth is a crucible of different chemicals, including various acids, enzymes, bacterial toxins, and sulfur compounds. An inert element like gold survives this hostile environment better than most materials mankind has invented.

While compressed gold fillings, rarely done anymore, were 100% pure gold, the gold used for cast fillings (“inlays”) and partial crowns, and crowns is alloyed with other metals to increase hardness. Additions to gold include indium, platinum, and palladium. When bridges are made of cast gold, more strength is needed, and the percent of gold is lowered a bit. However, I rarely use gold alloys with less than 70% gold.

Another fine property of gold is that it can be cast to a very thin edge, and burnished to fit the tooth even more accurately. Tight marginal fit is a key feature that makes dental restorations last. Inaccurate margins are the main reason resin fillings and porcelain crowns fail. When there is a microscopic gap between where the restoration ends and the tooth begins, bacteria can enter and eventually cause new decay.

Metal, including gold alloys, can be strong even when cast very thin. Ceramic materials must be at least twice as thick as gold alloys to have enough strength to last in the mouth. If not made thick enough, the usual result is porcelain fracture, especially on second molars. Think about it. Hammer on a thin porcelain dish and a thin sheet of metal. Which one will shatter into pieces? Thick crowns mean having to reduce more tooth structure, which frequently results in pulp deaths and root canals.

Here is something you probably did not suspect. The tooth in the middle of the picture is an artificial one, replacing the patient’s second premolar. This bridge is done in sections. So as not to cut down too much of a 1st premolar with fragile gums, I did a partial gold crown with a slotted keyway. No one can see any gold from the front! The tooth on the right is a crown with porcelain and silver-palladium alloy, welded to the replacement tooth. The back assembly locks in the front gold crown’s keyway to make a stable bridge. My first choice is always an implant to replace missing teeth, but the patient did not have sufficient bone for implant surgery.

View of the chewing surfaces Note the silver key that affixes porcelain replacement tooth in middle to keyway in back of partial gold crown. None of the metal is visible when the patient smiles.

Are Metals Safe in the Mouth?

You can’t believe everything you read. You will hear “holistic” healers claim you must get all the metal out of your body to achieve perfect health. This is a bizarre recommendation, as the hemoglobin that carries oxygen in our red blood cells is based on the element iron. Last time I heard, iron is a metal. Other essential trace nutrients that are metals include copper, zinc, chromium, and manganese. We cannot live without these metals.

There is no scientific basis for avoiding metals in dental restorations. True metal allergies are very rare. The only one I have encountered has been to nickel. To my knowledge, no gold dental alloys have any nickel content.

Think about this also. Humans routinely have joint replacements. Many are made of various metal alloys. Our highly biocompatible dental implants are made out of titanium, after early experimentation with crystalline ceramics resulted in implant fractures. Why would metal be safe for joint replacements and dental implants, but unsafe for dental crowns and fillings? The admonition to “get the metal out of our bodies” just does not make any sense.

What Would We Do Without Gold?

Don’t get me wrong. I really appreciate recent advances in resin and ceramic technology. In esthetically critical areas of the mouth, resin and all-ceramic systems have allowed me to more easily match natural tooth color while reducing less tooth structure. With zirconia crowns, we finally have a white material for 2nd molars that resists breakage. (But they have the problem of being hard to bond, and coming loose.) Still, nothing beats the tensile strength of metal alloys, even at relatively small thicknesses. Gold alloys add the important advantages of easy castability and ductility to achieve tight marginal fit. In all the years of its use, nothing has beat gold alloys for tooth restoration in areas that don’t readily show in the smile.

Patients always think about looks and cost, and dentists always think about durability, and for good reason. Doing a quality gold filling once results in far less trauma to the pulp than replacing a resin filling six times during a patient’s lifetime. Although gold fillings, crowns, and bridges may seem expensive at first, they often save patients money and root canals over their life.

Kim Henry, D.M.D.

December 15, 2016

35 Years Licensed to Practice

A Trip Down Memory Lane

The year was 1980, and the place was Augusta, Georgia. It was 35 years ago this May that I learned all my doctoral requirements had been satisfied, and I was cleared to graduate from the Medical College of Georgia School of Dentistry.  A few classmates thought our Dean was bluffing about holding them up because of unsatisfied gold filling requirements. Those guys had to stay during the summer and do nothing but pure condensed gold fillings.  But like me, about 60 of my 65 classmates were deemed ready to take the Georgia State Dental Board for which we were all preparing in June.

Graduation was a big deal at Medical College of Georgia, as it is in most college towns. I think MCG rented the Augusta Civic Auditorium to have enough space. First, there were some Associate degrees awarded to the radiation techs, dental lab techs, and physical therapy assistants. The vast majority of degrees awarded were Bachelor’s, awarded to nurses, physical therapists, medical lab techs, and dental hygienists. Finally, the PhD, MD, and DMD degrees were awarded to the researchers, physicians, and dentists. Each of us had to walk on stage, shake the President’s hand, and receive our sheepskin. I was quite a prankster at the time, and searched high and low for a hand buzzer to use on the college President. Guess it was fortunate I never found one! Degrees in hand, we medical and dental graduates were ready to take the Georgia State Boards.  Without a state license, it was impossible to practice anywhere and actually earn a living! 

Few patients realize how difficult the various state dental boards were at that time. In Georgia, applicants had to do resin, amalgam, and cast gold fillings on live patients. We were tested on a lot more procedures in the lab, and had to take a written test on Georgia practice law. My patients faithfully showed up for the Boards, but not everyone’s patients did. A patient not showing for this important appointment may mean the young dentist could not practice for another six months, when the Board was given again. It was not uncommon for us poor dental students to have to pay patients bribes in order to show up for this grueling test.

There were several Board examiners on the clinic floor those two days, and I was lucky enough to get an amiable one. He was building a swimming pool behind his house, and we bantered back and forth about that subject during my work on patients. It kept him in good humor, and our conversation relieved the incredible stress on me that this important exam imparted.

Casting my gold filling in the lab went flawlessly, and all the examiners seemed to like my work. Soon a notification came in the mail that I had passed! I was legal to practice, at least in Georgia. Later, while in the Navy, I took North Carolina’s and Tennessee’s Board for good measure. (I never practiced in either of those states, but still keep my license active in North Carolina, because it was such a hard exam!)

People don’t remember how tough the early 1980s were. We had double digit inflation AND unemployment.  Interest rates were approaching 20%! America was in a funk with hostages in Iran. An actor named Ronald Reagan had yet to be elected president. The future looked pretty dim for us new graduates. Hardly any older dentists needed younger associates. The few ones that did, sure didn’t want left-handed graduates like me.

The harsh reality was that almost no place in Georgia could support additional dentists in 1980. Only one county in South Georgia was actually recruiting for a second dentist to serve its population of 10,000 people. With demographics like that, I thought, what could go wrong? (Plenty that I did not realize at the time.) I spent my life savings on a piece of land that was a cantaloupe patch. I still remember going to the county courthouse and registering my new dental license by signature in a huge bound book over 100 years old. Two local banks lent me a good amount of money at high interest to open a new dental practice in the small rural town that was the county seat. Just my luck that year the county had its worst drought in 75 years, and crop failures went with it. 1981 was not much better. After my fledgling business folded, I spent the next seven years of my life trying to get the guts to buy my second practice. That initial business failure was quite the personal defeat for me. But all one can do is keep trying, and eventually success will come.

Well, here it is 35 years after graduation. I have actually treated patients for 38 years of my life. You see, Medical College of Georgia’s Dental School was quite progressive for the time, having us starting to treat patients in the spring of our freshman year. So by 2017, I can claim to have healed fellow humans for 40 years!

My professional life has been quite an adventure, meeting dentists at conferences all over the world, as well as treating indigent patients in Lebanon and Peru.  I will have to admit these last years practicing in the beautiful Henry Building sure beat my early days in South Georgia, the Navy, and a couple of Atlanta clinics that will remain nameless.

God willing, I intend to practice for at least 50 years like three dentist-heroes of mine. My wife may not let all those years be full time practice. It is rewarding to relieve human suffering, and put diseased tissues back into healthy condition. Even after thirty five years, having the legal privilege to cut and repair human tissue is an awesome responsibility. I have helped a lot of patients all these years. If you are reading this, you are probably one of them!

Kim Henry, D.M.D.

May 9, 2015

 

Why I don’t use Invisalign

There are a number of clear orthodontic aligner systems on the market. The name that patients know best is Invisalign®, which is a product of Align Technologies. Patients always ask me for Invisalign, and I tell them I don’t use that brand of aligners. Why not?

Invisalign costs a lot more than other aligner systems. Therefore, patients must pay a lot more to have this particular brand of aligners.

Align Technologies wants dentists to take a weekend course and be “licensed” to use Invisalign. It is ridiculous for a dentist like me, who has been doing orthodontics for over twenty years, to have to spend nearly $2000 for such a proprietary weekend course, the sole purpose of which is to teach me how to use their product!

Align Technologies utilizes a team of lawyers who try to put other aligner companies out of business for alleged patent violations. Aligners have been used for many years before Invisalign was invented. I don’t like corporate bully-boys who try to eliminate their competition this way.

Align Technologies is a publicly traded company which must answer to shareholders. Their business is to sell as many aligners as possible. I have seen Invisalign treatment plans that were overly aggressive and had little chance in success. Many inexperienced dentists get into trouble when they are “sold” such cases by Align Technologies.

Finally, as you can see in the “Lab Work Made in USA” section of my website, I support American labs and American jobs. Align Technologies has offshored its aligner fabrication to Mexico, and its clinical staff planning the cases to Costa Rica. The labs I use for aligners are 100% U.S. based.

Consumers are too easily influenced by advertising hype in printed media and television advertising. Just because something is highly advertised does not mean it is the only game in town, nor the best deal.  Patients don’t know which brands of dental materials work best, nor which are the most cost effective. Leave that decision to the experts- the dentists who use them!  Be assured that I will always be concerned for the health of your mouth AND of your pocketbook.

CORPORATE ORTHODONTIC CARE- A BAD MOVE!

Parents of a 13-year-old child came in to have me review the appropriateness of their son’s orthodontic treatment. The father had wanted to bring their son to me for treatment originally, but the mother saw an advertisement for a chain of orthodontic clinics, promising substantial savings. The mother’s wish prevailed, and the child was 1 year into orthodontic treatment at this clinic with little progress.

I examined the boy. His was not a particularly difficult orthodontic case. I could have treated it in a little over a year and a half. But the corporate clinic had only fabricated some kind of removable expanders the child could not tolerate wearing regularly, and nothing much had been accomplished in the year of treatment.

It was hard to give the parents my conclusion. “I hate to tell you, but if I were to treat this case as it should have been when you started, it will cost you just under $4000 to complete. I guess your only consolation will be you didn’t spend much on the treatment that did not work.”

The mother looked visibly disturbed. She said, “Oh no. We have already paid $4000 for the treatment that has been done so far!” This woman had brought her son to a corporate orthodontic clinic thinking she would save money, and they totally wasted more money than what I would have charged to do the case correctly!

Not to brag, but I have been doing complete bracketed orthodontic cases since 1987. I know what I am doing. If patients cooperate, we get cases done quickly. I know a hard case when I see one, and have the sense to refer it to a select few orthodontists I know the ones who are super-competent.

Patients heed my recommendations about orthodontists very seldom. They listen to what I say. Then they go home and ask their friends and neighbors where to go, or they see some silly TV advertisement for a corporate orthodontic clinic, and go there.  Many times, their case will never be completed correctly, if it is ever completed at all!

One of my adult patients asked me about straightening his teeth. I could see his case would be very difficult, with a high probability of needing jaw surgery to complete. I made a strong recommendation of one or two excellent orthodontists for such exacting treatment. The patient ignored me, and went to a corporate clinic. Fortunately, he later called telling me that they planned to do his initial exam and put the brackets on the same day. This was preposterous!

Any sane dentist would do an exam, take records, then do analyses and feasibility studies to work up such a difficult case as his. I spend at least 2 hours of analysis to work up an easy orthodontic case! Timing in orthodontics is often critical as well. Many cases, if started too early, will drag on for too long. These days, I often post photos of patients’ mouths online (omitting patient name, of course) and seek other orthodontists’ opinions about how the case should be treated. It would be ridiculous to put brackets and archwires on a patient the same day as the exam!

After being warned of the foolhardiness of proceeding, this patient changed his mind, took my advice, and saw a competent independent orthodontist. This is not always the outcome! Unfortunately, too often corporate orthodontists succeed in slapping on brackets and archwires to “lock in” the patient’s treatment at that clinic. Only afterwards do they try to figure out how to treat the case!

All good orthodontists forward a copy of their findings and treatment plan for a patient case to the treating general dentist. I virtually never receive these from corporate clinics, leading me to question whether there is even any logical treatment plan. I have received requests to extract teeth from corporate orthodontic clinics, then had to demand a rationale for the extrac­tions before I proceeded. I guess these orthodontists are under such pressures to perform, they allow no time for communication with the patient’s dentist!

Corporate ownership of orthodontic practices began in the early 1990s, as a result of the oversupply of orthodontists. Private equity investors thought they could use the same sales and business techniques to straighten teeth as they used dealing with auto repair and vacu­um cleaners. Health care is different, because all humans are all unique. No two orthodontic cases are exactly alike. There are even some orthodontic cases that should not be attempted. It is important that treating orthodontists not be subject to the will and profit incentive of non-dentist investors to treat the maximum number of cases without regard to appropriate timing or case difficulty or without sufficient diagnostic preparation.

Not every case I have seen from corporate orthodontic clinics has been done incompetently, but there are enough substandard case completions to be worrisome. One thing for sure: I don’t see any patient cost savings from corporate clinics, despite what is claimed in their glitzy advertisements.

As with every other service, I have personally found that the highest customer satisfaction is given by professionals who own their own business. It is true for general dentistry, and it is true for orthodontics as well. Please be skeptical about TV, radio, or print ads telling you to patronize any particular chain of orthodontic clinics. If you have any doubt before treatment, don’t hesitate to ask me about any particular orthodontic group you are thinking of using.

Kim Henry

January 24, 2015