Made Better in Japan at the Wall Street Journal:
“That’s omotenashi,” Thompson explains, “a kind of hospitality that involves anticipating what your guest needs.”
Finished another root canal today, which means I can stop worrying about that person’s tooth. Wrote up an extensive treatment plan. The school is generally horribly inefficient — though it can be a great place to learn if only you have the right instructors.
Now, I’m at home, waiting for Mykala to get here. She’s at work until 10pm. We don’t see one another nearly enough: maybe two hours on a good day. Last night, she fell asleep in my arms on the couch. That’s my absolute favorite.
That is a tooth, with its friends milk and carrot. I think that sums up why I love Sesame Street.
When I see a patient, they generally need a dental device that fits with a tolerance of microns. “How does that feel?” I’ll ask. To check, they bite down once. After that, two things can happen. If you got it right, they’ll nod. You live for that nod — you spend hours in lab for that nod. I’ve spent entire afternoons separating stone from mould just to get the nod. I’ve redone impressions, asked for third opinions, agonized over silly little things, for the nod. The only thing better is when your instructor comes by and you get to show them you are, in fact, not an idiot and here, look, there’s physical proof of it — see for yourself, they’re nodding.
I am nervous whenever I’m in the School of Dentistry in Moos Tower. Even on days like today when I have no patients scheduled, I am constantly aware of a sensation of compression: my heart beating in the back of my throat.
I noticed this today as I was pouring the stone to produce an altered cast. Nothing broke, nothing leaked, nothing was lost. We’ll get this fellow his removable partial dentures (upper and lower) in a few weeks, and things will be fine. So, it’s peculiar that I’m still so full of adrenaline — I wonder if my subconscious senses danger, even though nothing truly bad has happened at school for quite a while.
George Monbiot’s “The Lairds of Learning” (via HN) is exceedingly important:
But the academic publishers get their articles, their peer reviewing (vetting by other researchers) and even much of their editing for free. The material they publish was commissioned and funded not by them but by us, through government research grants and academic stipends. But to see it, we must pay again, and through the nose.
Not having anything go really truly catastrophically poorly at the clinic yet, I have been wondering how I will explain to a patient when, inevitably, things go wrong. For example: “Whoah, this does not fit.” Or, “That tooth really did not last long at all.”
One slip, and I gave myself four extra hours of lab work. Here’s how.
At the School of Dentistry, we are short on cash. (Our dean is also leaving, but that’s a story for another day). So, the students (us) do a lot of intricate lab work in order to make the stuff our patients need (crowns, bridges, etc.). That way, we don’t have to pay a professional lab to do as much of our lab work. This does the following:
The seniors at dental school are elated: boards results came in and most of them are past their last large hurdle of school. In the meantime, us third years are emerging from the trenches to start out charge toward graduation. In 60 days, we’ll be the oldest at the school.
Earlier this semester, there was a day at school when I finally stopped being afraid. I can’t point out the box on the calendar when it happened, but at the end of that day I realized something had clicked. Reminds me of this quote:
Friday, I’ll be fitting a gold crown, a single tooth removable partial denture, and a multi-tooth maxillary removable partial denture. So tomorrow, I deliver over $2000 in dentistry.
If it fits.
Regarding trying new dental materials, Dr. Sorenson told me this one:
Be not the first by whom the new are tried
Nor yet the last to lay the old aside.
—Alexander Pope
These days, the most technologically advanced dental crowns are made from an interesting combination of materials. Before I get into that, let’s first talk about how your teeth resist breaking in twain.
The toughest building materials have a combination of strength and flexibility. Think about wood or steel: they have strength (compressibility, tension), but because their rigidity is not infinite, they also derive durability from their ability to flex and rebound under load.
Banana equivalent dose - Wikipedia:
A banana equivalent dose is a concept occasionally used by nuclear proponents to place in scale the dangers of radiation by comparing exposures to the radiation generated by a common banana.
Today, a Listerine ad taught me there are barnacles on your teeth. Wow!
New word, learned from an endo and perio resident, separately. “Whizzie”, meaning “wisdom tooth”. Apparently these residents love their slang. I don’t think I like the word. Maybe it will grow on me? As I heard it today:
“It’s definitely not a maxillary tooth — look at the root structure. Now, I can understand your confusion—I mean it is a whizzie—but this is mandibular molar.”
Just got done reading Atul Gawande’s book Better: A Surgeon’s Notes on Performance. First off, it’s a fantastic title: it reflects the simplicity of Gawande’s language and the complexity he manages to express with those words. The book explains how, through “diligence”, “doing right”, and “ingenuity”, surgeons can improve. The anecdotal essays are fascinating and well-written… and the ideas are inspiring. The idea is, the greatest gains we will see in the delivery and efficacy of healthcare lie not in the raw advances in science, but in the persistent, thoughtful efforts of those “on the ground” fighting the same problems every day. Here’s a bit where Gawande describes the thinking of a surgeon turned malpractice lawyer:
Today I learned that love is an action, but centric relation is a feeling.
The American Way of Dentistry is the dentistry article of this year:
The medical profession has struggled to replicate dentistry’s achievements in disease prevention with its “health maintenance” model. Dentists, by emphasizing preventive measures—like biannual checkups and cleanings, fluoridation of community water supplies, the use of fluoride toothpaste, and encouraging patients to eat less sugar and processed foods—have reduced overall treatment costs as well as pain and suffering to a degree medical doctors can only dream of. They have done so in part through a structure of dental benefits that is far more punitive to those patients who slack off on prevention, or for whom prevention fails, than anything health insurers typically contemplate.
Read Memories of Bob Gorlin in Northwest Dentistry (the journal of the MDA). He has an entire syndrome named after him, and a clinical sign. He worked at the U of M School of Dentistry for 30 years. Well, he was the SOD for 30 years. But, that’s not the full story.
↓ More