Pat Yourself on the Back Good Doctor

A number of years ago I built a small greenhouse in my yard to help extend the exceedingly short summers we experience living in Marion, Utah. The small community of Marion sits at 6,500 feet, nestled against the base of the beautiful Uintah Mountains. Cultivating a vegetable garden in that harsh climate can be quite challenging. Nevertheless, my wife, Mary Jane, has learned the secrets of high altitude gardening very well.

This greenhouse is not heated. But, it does have a small fan that keeps the two outer layers of greenhouse plastic separated from one another, giving the vegetables inside a little more protection from the cold. This small fan runs 24/7. It runs when it is twenty-five below zero in the dead of winter. It runs when the sun is beating down on it in the middle of our short summers. When I purchased the kit for this greenhouse, I remember thinking to myself, “That fan is going to take a lot of abuse. I should purchase a second, back-up fan, for when the original one stops working.” That was seven years ago. The original fan is still running. In my opinion, that is remarkable durability. Now that I have heaped praise upon my little greenhouse fan, it will probably stop working tomorrow. That’s life isn’t it…

Anything that holds up well, especially in harsh conditions, we consider to be remarkably successful. My little greenhouse fan operates in a pretty harsh environment. Nevertheless, this environment is nothing like the cavity we refer to as the human mouth. Now, that is harsh! Our restorations are called upon to soldier up, and perform like my little greenhouse fan. On top of that, they must look good as well.

We bond into place the toughest, most esthetically pleasing, and biocompatible materials we can find. Then immediately, the assault begins. First, it starts with acidic beverages, then acidic, hot beverages, followed by acidic, cold beverages. These daytime, acid baths are followed by the nighttime orgies of streptococcus mutans bacteria, and their friends, spewing their caustic excrement throughout the mouth, especially at the margins of our carefully placed restorations. This daily bath of corrosive chemistry is often accompanied by nightly beatings, as the patient clenches, grinds and gnashes their teeth together for hours on end. With some patients, these daily attack rituals can also be augmented by fingernail biting, fishing line biting, thread biting, and/or the biting, and cutting of almost anything imaginable, when either a knife or a pair of scissors is not handy. On top of all this, there are the more commonplace duties, the meals, the snacking, the chewing of year-old beef jerky, or worse, the stale Big Hunk candy bar, and the countless crisp apples and carrots that are torn apart without regard to the tremendous shear forces generated against our restorations. Wow! Our restorations put my little greenhouse fan to shame.

Thanks to some great material scientists, and chemists, we have outstanding materials with which to perform our craft. But, that is just the beginning. The rest is up to us. If our application of these restorative materials is inappropriate, or if there are flaws in our technique, the failure rate goes up. Any way you slice it, there is a lot that goes into the delivery of excellent dental care for our patients. The term doctor is appropriate and should not be taken lightly. It is our responsibility to assimilate all of the pertinent information, starting with the patient’s temperament, circumstances and objectives. What are we trying to accomplish together? Are we looking primarily for strength, beauty, or both? Does the patient have abusive oral habits that could negatively affect outcomes? Where is this patient on the homecare spectrum? These are just some of the questions that must be answered in order to provide our patients with the best possible restorative outcomes.

Once you have decided upon the most appropriate restorative application for a given situation, then you employ your very best restorative protocol. That is no small task either. Many of the materials we work with are very technique sensitive. Furthermore, you are not working on some inanimate object, laying lifeless on the workbench. No, everything you do is attached to a live body, complete with feelings, emotion, and painful nerve endings extending to every square millimeter of everything you come in contact with during treatment. You must wade through saliva, gorp, and hyperactive tongues, making every effort to maintain the necessary dry field to accommodate our finicky restorative materials that do not like moisture until they are firmly attached at their intended location. And, once the restoration is in place, you then do your best to be the consummate educator, and the eternal teacher, by continually reinforcing the importance of good home care, and regular exams.

Yes, there is a lot that goes into the delivery of excellent dental care for our patients. Doctor, you and your team do an excellent job! Give yourself a pat on the back. Nothing lasts forever. Even the little fan in my greenhouse is going to fail someday. And, so will some of your restorations. That doesn’t make you a bad dentist. You are a good dentist, doing your best in a harsh environment, and often under difficult circumstances. Even our best work sometimes fails. Learn from it. Embrace it, and quit blaming yourself. Failing restorations do not make you a failure! Every effort you make to do a little better, and be a little better at what we do as dentists, improves the life of another human being. Now, isn’t that wonderful!

Dr. Mark R. Taylor UDA Treasurer