Dr. Von Bulow's Articles

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.

Today I sent in my re-licensure paperwork and a check made out to the State Board of Dental Examiners.  And when I print out the ole P&L report and scan the cost of doing business with dental labs, dental suppliers, and the Tax Man (Did I actually leave out insurance expense?), the tab for my now nearly classic license looks like a pretty sweet deal.

But trust me; I won’t be making too many “sweet deal” remarks around recent grads who qualify only because they’ve already spent hundreds of thousands for school and hundreds of thousands more if they’re ready to roll the dice on opening a new business. 

Yeah, $335 isn’t half bad.  Shucks, what with the value of gold these days, you could almost pay the lab fee for one crown with three bills and change.  And I hope you’ll forgive some dang cynicism creeping in; think maybe I’ve been watching a little too much Doc House Monday nights.

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So I realize I’m getting a little older because I don’t wake up in the middle of the night any more, totally convinced I’ve been removed from dental school for calling Doc “Wrath of” Kahn a little weenie.  I guess birthdays do have some advantages.

For the most part, I loved being a student.  Shucks, the only times I remember being under the classroom gun were during Catechism and dental school; everything in between was pure hot fudge sundaes.  My teachers always had my unconditional attention and respect; with the exception of dental school, I always felt the feeling was mutual.

Of course, my family always took a personal interest in what I did.  Sometimes it was almost embarrassing.  If my brother had only known I could actually use dental floss in grade school, he’d have told the world.  And today, I always view patients in the context of family.  I kid around with the family thing during a patient’s first visit, sharing most of my relatives are Sicilian (the Familia never forgets and they’re bent on revenge.)  Not a bad guarantee for my best clinical effort.

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So last week I returned from an amazing annual dental conference experience and I couldn’t help but notice how much more inspiring those things are when a bunch of dentists aren’t doing all the talking.  And that’s one reason why I’m writing.

It’s a curious time when there are zero cab lines at McCarran Airport in Vegas but two parking tickets on my windshield at LAX.  Guess it would help if my ultimate vehicle had a spot for a license plate up front but two citations in a parked car seems excessive (unless the plates also serve as my mailing address.)  Anyway, if the LAPD is set on pumping my money out of the economy at $70 a pop these days, it’s back to Ontario, even if I get to see Sacramento on the way to Sin City and other destinations now unknown.

But for dental patients and even the 50% of you that stay away, now may be the best time ever to invest in your oral health and travel non-stop to the dentist.  And I’m saying this before I’ve paid my bills and after I’ve written my side of our annual team member growth conferences, so I’m about as objective as I’m gonna get.

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So I don’t know about you guys but I sure do appreciate my recovery time. In fact, for me, the Holidays provide the perfect opportunity to recover big time.

And world-class recovery isn’t necessarily all about taking a Louisville Slugger to the alarm clock or going Kobayashi with chili-cheese whatever all day or letting the dishes stack up or wearing the same old Trojan National Championship FB jersey all week (Shucks, that would mean Bruin fans could never recover properly and they need it more than most. Maybe in their case we could opt for “We held BYU to 59 points” tees.

In any case, research shows that in order to grow, we need to experience stress and recovery in fairly equal portions. Dr. Jim Loehr believes we most effectively develop physically and emotionally when our day-to-day routine consists of a series of stress/recovery intervals. Loehr is a world-renowned performance psychologist and CEO of Human Performance Institute in Orlando, Florida. Jim has worked with Fortune 100 executives, FBI hostage rescue teams, Pete Sampras, Dan Jansen and numerous other elite athletes…and me (twice.)

Compromising the recovery component of our oscillation through life can have some fairly dire consequences. Now that I think of it, I’m sending a copy of this column to spin instructor Pearl who doesn’t believe in recovery but is a UCLA grad and doesn’t follow football and that’s probably her recovery angle right there and there I go talking to myself…again.

Back to the troublesome health implications; there are many just within the scope of what we see in dentistry everyday. When little kids suffer allergies, parents will often report some seriously loud nighttime teeth grinding. The grinding is the body’s adaptive effort to open up the ear canal and relieve congestion produced by big tonsils and adenoids that are part of a stressed immune system. If the allergies go untreated and recovery time is significantly impacted, the result can be altered oral and facial development as well as slowed growth. In the adult airway version, obstructive sleep apnea puts folks at risk for stroke and heart attack. We definitely need effective recovery time; without it, our quality of life and length of life can take a Louisville slugging.

And as long as I’m going Louisville, why shouldn’t I complain about baseball crimping my recovery time.

Like most American males my age (somewhere between 32 and 55.32) playing catch with my dad was my intro to sports. And at risk of my dad coming back and haunting Doc (wrath of) Kahn until he goes over my final Mock Board exam results just one more time, I’m here to say I’ve had it with baseball.

I’ve already gone from being a kid who played over-the-line everyday all summer and knew every Big League batting average to seeing the National Pastime as I do now. Today, attending a ballgame is a chance to eat junk food, wash it down with a cold, frosty beverage, read a book, BS, get some sun, defeat insomnia and seize 3-5 hours of recovery time. Simple as that.

And now, a billionaire billboard jockey won’t pay an extra $20 million over eight years to some punk in cleats because $160 million just isn’t enough for a 29 year-old guy who’s already set for life playing a kid’s game in front of a bunch of folks who’re wondering whatever happened to their 201Ks (I think I just threw up in my mouth.)

So, thanks for the memories. Shucks, now I’m probably gonna have to start watching ice hockey or…gulp…soccer. But I won’t be losing any sleep over baseball…zzzzzz.

I know; what a ridiculous title? But you have to admit, you’re probably totally intrigued about what the Tommy Cruise I’m thinking about or maybe you’re already moving on to unravel that tangled puzzle we know as the City Manager’s Weekly Report.

So I’m not talkin’ about Old-Time Rock n Roll or even the yucky HAZMAT breed of biomechanics that grosses out most of us non-medical specialists. But I just did have an SAT flashback even though back in The Day I didn’t even know I was taking The SAT when I was taking it.

Anyway, I’m just talking about teeth.

So most of us know teeth can be risky business; some of us know the hard way. Here’s the thing; please don’t feel so guilty about having a track record of tooth decay and fillings that seem to expand in size every time the Trojans mop up on the Bruins.

Okay, you win. You can feel guilty if you’re not trying and you know better. And sometimes guilt is good for you; just ask my Sicilian traveling production manager, Aunt Clara.

But getting cavities and suffering from tooth decay is mostly the outcome of our lack of resistance to disease. And yeah, it’s okay to think of tooth decay as a disease. Not being able to stop shoving Jolly Ranchers into your pie hole is not a disease; armies of aggressive bacteria using sugar as a medium to produce acid that will rot away weakly resistant enamel is a disease. Tooth decay, when it comes right down to it, is a bacterial infection. And some folks are more vulnerable to the infection than others.

Doesn’t it make sense to figure out who’s at risk sooner rather than later? Once dentists can assign a degree of risk to a particular oral health challenge, we’re better able to personalize care and make the care more preventive than interventive. Shucks, my world-famous continuing education guru, Seattle’s Doc Kois actually says stuff like, “No dentistry is as good as no dentistry” (And to think I pay Dr K 5Gs a pop to figure out how to best restore broken down teeth and mouths.)

The message is materials and approaches for restoring damaged teeth have made the restorative experience far less invasive than in the past. And the earlier significant tooth decay risks are identified, the more effectively we can follow the natural design of our enamel-coated chewing body parts. Kind of like the dentistry version of “keepin’ it real.”

Today, systems exist that can measure risk before tooth decay disease has even started. One particular technology, the Carifree system, takes only a few minutes in the office to quantify risk. Clinically, the experience is pain free and involves swabbing plaque off two different tooth surfaces. Carifree can even be used to measure risk in infants. The cost of the screening is less than the cost of one filling.

We can also detect risk for tooth decay just by studying patterns. If someone has active tooth decay or has had a history of tooth decay on the smooth enamel surfaces between teeth, we know there’s an increased risk. And we’re all at greater risk as we age and produce less saliva. Reduced saliva flow is also a common side effect of numerous medications.

Folks with a higher risk for tooth decay can receive fluoride in any number of ways and increase their cavities resistance. And we know the sugar substitute Xylitol potentiates the anti-bacterial capability of fluoride. Antimicrobial rinses help. Oral hygiene instruction and heightened monitoring are musts. Plus today, laser technology helps us detect tooth decay at very early stages.

So don’t feel guilty…unless you don’t stop by for a quick risk analysis from your dentist.

So I realize last week it seemed like I spend half my time talking to myself and most of the rest of the time interviewing imaginary public figures. And see what happens to you after you’ve been looking at crowns and veneers for decades and have OM Dalila on your case all the time?

Thing is, some of my favorite images are those I hold onto inside mi cabeza and some of my most fun recovery time gets generated by my often vivid imagination. I once heard Anthony Robbins mourn the adult loss of child-like curiosity but I hope he wasn’t lookin’ at me. Some may call it immaturity but shucks; I think being child-like can work just fine for veteran molar jockeys like me.

So I’m a week or so late for Thanksgiving. And my tardiness means I’ve undoubtedly watched “It’s a Wonderful Life” again and shed a tear or twelve like I do every year George Bailey wishes he was never born.

And there have undoubtedly been easier times to locate a slice of silver lining on Turkey Day. But once I’m past the irony of Bailey Building and Loan Association getting torpedoed by VP Cheney look-alike, evil Mr. Potter, I’m back in the spirit again.

Through it all, the movie’s about people. And true, director Frank Capra was an insufferable sentimental softy but who cares? The theme of the film is written on guardian angel Clarence’s note, “He is not a failure who has friends.”

So this November, when I’m reciting everything I’m grateful for on the way into the office every morning, I lead off with family and friends (I know; talking to myself again…and driving!) And it almost seems counter intuitive to not retreat into some defensive posture when times get tough. But reaching out has always worked better for my having the results I really want (I talk to myself about that every morning, too.) Seems like when you reach out and declare to friends and family what you’re going to do and how you’re going to do it, they tend to help hold you to your word. Trust me.

So if, like me, you’re committed to staying healthy, share the commitment. If you openly declare good health as something you want, you’re way more likely to see the opportunities. If you resort to four walls and the Business Section, all the bad news can help generate a self-fulfilling depressing prophesy.

Back in The Day, when I came home with a robust 2.13 GPA after one quarter of college I felt like a total failure. So my family had committed to me for a lifetime and this was their reward? My dad and I had a little talk; it went something like this: “Jack, I love you and I’ll be proud of you no matter what you do, as long as you do your best. As long as you’re giving it 100% I’ll support you with whatever it takes. If you can’t give it your best, you’re on your own. Am I clear?” I told Dad I’d do my best; I was going to go to dental school just like I said I would. Me, disappointing my dad, just wasn’t an option.

So Dad got me a night job in a warehouse and I hit the books rigorously for the next three years. And I still remember the clear, wind-swept afternoon Dad and I walked the campus during open house, months before I started dental school at USC, my first choice. And I’ll never forget Dad’s smile.

I was never more committed to doing anything than I was to giving it my best during those three years at Cal State LA. And if you’ve done something once, you know you can do it again…with a little help from your friends.

And that’s why I love Thanksgiving and…“It’s a Wonderful Life.” Especially this year.

When you’ve been around here as long as me you risk getting accustomed to some stuff. But then again, you really never know what’s gonna happen, right? I totally know it sounds like I’m talking to myself…or even worse, writing to myself…but everything’s going be okay because it’s all part of a formula.

So I grew up with only a handful of friends and who knows; maybe that’s why I was drawn to dentistry? And maybe there really is a reason for everything and maybe a few decades spent with only one mouth running (in my sleep, on the driving range, in front of my checkbook, etc.) was part of some grander design? Might be that grander design is the perfection of the virtual interview.

And so once again I give you CBS curmudgeon extraordinaire, Mr. Andy Rooney. Andy virtually called up Temple City Dental Care (TCDC) last week and asked for a post Election Day/ post USC loss to The Fighting Beavers apocalypse interview. Like I’ve shared here before, Andy’s always been a no-nonsense hero of mine; and he still asks a ton of open-ended questions. Rooney would still like to know why Chihuahuas, Sean Penn, and former smokers have such a huge chip on their shoulder and he also questions why a dang tooth brushing approach has such a self-important, high falutin’ name like the Modified Bass Technique (sounds like the World War II invasion of Colorado or something for cryin’ out loud.)

As always, the brief interview transpired right in front of El Pollo Loco and things went well in the absence of senior citizen discount Nazi, La Polla Loca (Rooney knows I only have to outrun him, not Ms. Loca.)

The opinions expressed in the interview in no way reflect those held by CBS, the BCS, TCDC…or God forbid, the Tribune.

“Andy, welcome back to Temple City; it’s really exciting having you back in town. Too bad you missed our election; we actually had a tie for third place and instead of recounting the 42 votes in question, the two bronze medalists just flipped a coin!”

“Von Bulow, are you gonna ask me a question or what?

“Okay Andy, I’m really interested in hearing your take on the election. I know you’ve seen it all: the Great Depression, World War II and everything since. But did you ever dream you’d see President-elect Obama?”

“Young Jack, I think this election might be one of the most pivotal this country has had; right in there with Lincoln’s and FDR’s in ‘32. And no, I wasn’t around covering the Lincoln-Douglas debates in 1858.”

“No need to get snippy Roonster; but what about Mike Wallace? I bet he was around; wonder if Stephen A. really had that fluffy Mohawk-doo that shows up on the Internet? But really Andy, what’s your take?”

“Dr. V, this election moved me. When I was born in 1919, my life expectancy was less than age 55. I’m very grateful to still be around and not only witness history, but actually get paid to write and talk about it.”

“Jackson, I understand you’re still the foremost DDS/elite athlete in the San Gabriel Valley, may I ask you a question? What about health care?”

“Andy, I’ll limit my response to dentistry. Keep your dental health preventive, use your dental benefits in ’08 or lose ‘em, and look for interest-free deals on stuff you’ve always wanted. But now Andrew, your thoughts?”

“JVB, 47 million folks without health insurance and millions more without enough of it is a disgrace. The cost of health insurance to employers for employees really calls for commitment and sacrifice, sometimes at risk to the business itself. Leaving the transformation of the system to the private sector alone is like putting the Crips in charge of collecting property taxes. The government needs to be responsible and play a role.”

“Just two more questions for you Andrew; are those your real eyebrows and have you ever heard about teeth whitening?”

“Look Von Bulow, I’m 89 years old; leave me alone. Bite me Molar Jockey!”

So it wasn’t that long ago I was still holding a major Cardinal and Gold grudge against my dental school alma mater. And one can only imagine how obnoxious things could have been around here if I had totally loved all my time spent at USC. Shucks, in spite of everything, we still have a full-out Trojan shrine in the office and even a beleaguered stuffed powder puff bruin hanging upside down by its little paw.

The only class I ever cut south of Jefferson was “History of Dentistry.” Yet, where was the love? If the class had been ‘History of Dental School” I know I would have shown up; because things must have been way more fun back before Doc “wrath of” Kahn arrived.

Used to be dental school was like some kind of molar jockey boot camp. Instead of “Good morning Jack” you might get, “You freakin ungrateful, untalented, brain-dead little scumbag maggot, what in the hell did you do to destroy this perfectly innocent, beautiful virgin tooth! CAN YOU HEARRR ME!!!?” Well, I guess that one wasn’t so bad; and maybe I just remember the good times because my mom was the patient. I dunno, we were all lower than whale droppings and teeth were beautiful, sexy virgins. No wonder it took me about ten years in practice to start feeling comfortable as a dentist. No wonder it took another ten to be comfortable alone with my own teeth.

Significant numbers of students were unhappy; the place was totally no fun at all. On the good days, students and faculty seemed to retain a mutual hateful adversarial relationship. We wore little zip-up barbershop smocks and the instructors had starched whites with three red Sergeant stripes on one sleeve; most of ‘em walked around with kind of a Dental Drill Instructorish cocky swagger…even when they were wearing white belts and white shoes (and trust me, that fashion statement even looked stupid in the 70s.) If it had been up to me, I’d have never made eye contact with the Warden, uh; I mean the Dean…or about 80% of the instructors.

A kinder, gentler, immeasurably smarter dean once told me he was way more inclined to lose sleep over the 10% of students who really enjoyed dental school back during Disco. And when you think about it, Pvt. Pyle from the film Full Metal Jacket never seemed very happy during his boot camp…until he went nuts.

The school produced excellent clinicians who could do the limited available restorative procedures really well but with the exception of the nutty 10% plus a few super well-adjusted individuals, most folks left school and didn’t want to come back. We learned the right way and the only way. I also learned the highway.

As time passed and exciting, innovative technologies were sweeping across the dentistry landscape, USC’s vision remained narrow; the school didn’t keep up. If you don’t look too hard, you’ll find a City of Temple City metaphor. But the good news is there’s still hope.

Today, the USC School of Dentistry is back where it belongs. The school is among the most progressive in the land, has world class leaders, retains first class faculty, and, believe it or not, happy students. The school is an inclusive culture embracing other learning disciplines ranging from bio-engineering to molecular biology and stem cell research to applied kinesiology and physical and occupational therapy. Today, Harvard University and USC are the only U.S. dental schools using Problem-Based Learning, an educational system emphasizing communication and a cooperative approach to finding solutions. The school has also made an impressive commitment reaching out to the community. I’ve never been prouder of my alma mater than when I visited the USC Mobile Dental Clinic in Santa Clarita and saw students making a difference for low income folks and obviously being moved and inspired by the experience. And having fun working together on a Saturday morning.

So after staying close to home for about twenty years, I also started removing the blinders and becoming more open and inclusive. By the time USC started turning things around, I had put on some major miles in search of continuing education of all kinds; took me about two decades to figure out there was a lot of stuff out there I didn’t know I didn’t know. Even wound up being a faculty member for an organization called Dental Boot Kamp. Ironically, this brand of Boot Kamp taught, among many other things, that folks retain information a lot better while they’re having fun.

Today, our practice works with chiropractors, applied kinesiologists, nutritionists, physical therapists and personal coaches. And one day I finally even managed a smile while looking the current Dean in the eye. The opportunity came shortly after my critical letter and his subsequent invitation to have a conversation. While we toured the D-school, I couldn’t help noticing the Dean greeting every student, faculty member, and non-faculty employee with a first name and a smile. I had to pinch myself.

It might be because of all those years of me listening to humming/ squealing power tools but I just don’t remember that many upbeat student-faculty encounters while we were writing our own chapter in the History of Dentistry.

But the best news; we also have those conversations everyday with our patients. And there’s more to come. And it’s fun. Even though the Basketball Trojans are being investigated.