Dr. Von Bulow's Articles

My Mom and Dad both had diabetes. And I know having the disease wasn’t part of their plans. My experience helping out my parents has helped me in more ways than one; here’s a shot at passing it forward.

My Dad was diagnosed with diabetes at age 50; he had had no obvious symptoms. The elevated blood glucose level showed up in a blood test taken during a check-up. Dad immediately transformed his diet; couldn’t possibly have been more compliant. Never saw Dad drink another cold one; good thing he wasn’t allergic to salmon and vegetables.

When Mom was diagnosed with the disease in her late-70s; she had loads of symptoms. In a health care/gender role reversal, Mom almost had to be dragged to an appointment with a physician. By the time Mom finally agreed to a visit, we nearly had to carry her in.

Dad enjoyed going to the dentist the way I enjoy Bruin football. In fact, one story has it he once sneaked out of a waiting room on hearing some distressing sounds coming from some poor soul receiving dental care nearby…and no, it wasn’t my office. Dad died of a heart attack a couple of months after I opened my practice here in Temple City, just one year into his retirement. We never did get around to even an exam and x-rays.

My Mom loved going to the dentist. After an early debate over Mom’s vision of ideal painless care with no local anesthetic (a rare debate I actually won) and some early fillings, Mom pretty much cruised through the next 15 years or so with no cavities or gum problems.

Mom didn’t walk anywhere up until about age 75. She ran. Mom used the Diabetic Diet way before she’d ever heard of it. Dripping wet, my 5-foot tall Mom never weighed more than 100 pounds. Up until diabetes-related neuropathy, mini-strokes, and progressive kidney failure, Mom could have danced teenagers off the floor.

A diabetes symptom I happened to pick up during a dental check-up explained my finding Mom with a whopping totally out-of-character 13 cavities. The cavities had resulted from “dry mouth,” an oral condition common with diabetes.

An even more common oral condition is periodontal disease (or gum and bone disease.) It’s estimated that 80-90% of people with diabetes also suffer from periodontal disease. Diabetes has a major impact on the ability of small blood vessels to facilitate the flow of nutrients to and removal of waste from body tissue. The result is tissue that doesn’t effectively heal.

So it’s bad enough that periodontal disease is a leading cause of tooth loss. For diabetics, the worse news is periodontal disease makes controlling diabetes even more challenging. And I often wonder about my Dad’s periodontal risk. Could proper diagnosis, continuing care, and consistent monitoring of possible periodontal disease have made a difference?

The irony is both diseases have so much in common. Diabetes and periodontal disease are both chronic and episodic; they’re managed not cured. Both diseases have an insidious onset but can easily, painlessly be diagnosed by objective numbers; and both have been proven to be connected to other health challenges such as heart disease and stroke.

If you’ve been diagnosed with diabetes, seeing your dentist is a must. And as in my Mom’s case, 6.3 million Americans suffer from the disease without the benefit of a timely visit to a physician and a diagnosis.

Please be responsible and see your physician and dentist. The statistical consequences for unmanaged periodontal disease alone equal about seven years of life expectancy and untold years of life quality.

So just do the right thing.

Okay, so a few weekends ago I went to a convention. And how would you like to be this close to the Magic Kingdom only to wind up being surrounded by thousands of dentists and tens of thousands of sales reps?

The California Dental Association presented “The Art and Science of Dentistry” in Anaheim on May 14-17 and I just couldn’t help but reflect.

First thing I noticed was my official convention On-Site Guide. It was sealed by a wrap-around ad from the Bank of America. The headline proclaimed, “WE HAVE MONEY TO LEND.” Hmmm.

Then I noticed what should have been first (and would have been first without our uncertain economy and my warped sense of humor;) all the women. When I was a kid-DDS and attended the CDA convention I was way overwhelmed by the wealth of womanly riches in the profession I’d so astutely chosen. Today, my appreciation has more of the depth you’d expect from someone who’s practiced dentistry since Disco.

But early on, for me, going to the convention was like spring break from four years in a boy’s Catholic school. My dental school class of 120 students included all of two women. Today, the men-women ratio goes to 50:50. These days, my perception of all the women in oral health is a little different than spring break (but not totally.) Experience has taught me women make all the difference in dentistry.

Hate to sound arrogant but you just have to respect a profession that gets it. In dentistry, the practice vision comes from the owner and its development and reality comes from team members (code for women.) Women create the culture. And it’s probably no accident that 2/3 of the folks who are smart enough to find a happy dental home are women too. Why not? Don’t women also make about 80% of important family choices?

So I just might be the living, breathing, grunting epitome of the typical surface-polite male. I can read a map so who needs to ask for directions? Show me a picture; I don’t need to read any instructions. Sarcasm used to be a hobby. And I did use the past tense.

I’ve been a total project. My Mom made me a life’s work. My dental family away from home has provided on-the-job training for years and OM Dalila, Dental Assistant Extraordinaire Dani, Singing Dental Assistant Kolleen, and Twin Towers of Hygiene Jen and Peg should all get medals. And I’ve even had formal training in active listening for cryin’ out loud!

So if I’m a functioning adult with perception and organizational skills that succeed on a level at least comparable to Shaq foul shots or former-VP Cheney’s grasp of reality, it’s only because of the women in my life.

I’m surrounded by caring folks who relate to others the way Picasso related to scratch paper. Talk about making a difference in the health care experience.

As I toured the convention floor, one by one, I ran into four of our own sales reps from Patterson and Pearson Dental Supplies, Invisalign, and Care Credit. They each complimented me on my practice but saved special praise for my team. They used words like “warm,” “family,” and “happy.”

A beloved mentor once shared, “We’ve got the best job in the World. All we need to do is show up, empower our team, give some direction when you know you should…and then just stay out of the way.”

And these days I’ll often ask for directions even before panic sets in. I remain a work in progress.

The CDA presented “The Art and Science of Dentistry” last weekend. And women provide about half of the science and almost all of the art. So I’m a male but even I know when to stay out of the way.

Within my very first few months of treating patients with Invisalign, something happened that I’d never forget. I saw someone’s life change and I had a front row seat.

I think of Diana every single time we begin Invisalign Care. And there are numerous reasons.

Forget that I never really liked Orthodontics when I was a student and therefore never saw straightening teeth as part of my clinical future. But I’ll be the first guy to admit receiving orthodontic care changed my life. Back in The Day, I just didn’t see me on the giving side of the proposition.

I actually used to cover my mouth with my hand when I was speaking. If early patients didn’t have canine-type reception, hearing Bolton was easier for them than understanding me. So I started my practice here in Temple City as the expressive dentist equivalent of a flabby personal trainer or a food critic who counted catsup as a vegetable.

By the time Invisalign came along (Originally the work of two MBA candidates at Stanford) I was way more than seriously curious about all the new clinical advances in dentistry. The office was loaded with cameras and computers and lasers…and I still felt a little threatened by the dental engineering also known as Orthodontics. Finally, I figured if two non-DDS types had dreamed up the system, there might actually be something to it. I gained certification as soon as GPs became eligible for training.

I met Diana at a Pasadena Chamber breakfast. I love Chamber functions because the folks who attend are such dedicated networkers they don’t even run away screaming when you tell ’em you’re a dentist.

Diana won a free TCDC Zoom! Teeth Whitening in the raffle held at the end of every monthly breakfast. After a while, she made the drive down Baldwin and within an hour or so had a smile about 5 shades lighter. After folks visit us and walk away with whiter teeth I’m more likely emboldened to ask a few questions. One question is, “Do you have any other concerns about your smile?” This time the answer was, “I know darn well you’re looking at it.”

Diana had had great whitening results and everything was looking good…with the exception of one badly discolored upper front tooth that was also sticking out at an angle not much unlike Sarah Brightman taking a curtain call in front of the rest of the lined-up cast of The Phantom.

Diana helped head up a local non-profit, her children were all grown up, her family had always come first; you’ll never meet warmer person. On Zoom! Day, plus 10 minutes, Diana shared she’d hated that tooth for at least 40 years. She never smiled without posturing to hide the tooth, hated having her picture taken, and subconsciously screened her mouth from sight, using her hand as a prop. Hmmm, been there.

Diana had heard all about Orthodontics but didn’t want braces. “What if we straightened that tooth without using braces and matched colors by placing a porcelain veneer without removing more than about 0.5 millimeters of enamel? Would you be interested?”

“Can you do all the work here?”

“Would you prefer that?”

I still attend the monthly Pasadena Chamber breakfasts. The scrambled eggs continue to need some work; there are more chiropractors present than dentists in the state of Nebraska, and the guy who leads the meeting is an unapologetic bruin honk (poor devil.) And the whole experience is a total blast.

Especially when Diana delivers her 20-second commercial with a big, beautiful freely expressed smile.

So maybe I’m a little sensitive about another birthday, okay?  But what’s the big deal with questions like “Is this one special?” or “How old are you now anyway?”   I wanna know how my vital stats make a world-class difference for others?  And even if they did, what’s in it for me?

I’ll tell ya right now, if any of you are VP Cheney rude enough to ask, you’ll get a lie in response.  And it’s your own dang fault.  Any questions?

Sometimes nature has an over-underestimated sense of humor and there you have my long overdue tribute to President Dubya.  Yeah, if son of Big George and I were both 75, we’d look pretty good for our age.  But there are some telltale Nature jokes/subtleties that give us away and make our old beat-up classmates feel totally better about themselves.

(more…)