Using the right systems is the "secret sauce" to successfully implement an orthodontic program in a general or pediatric dental practice.
In our heart of hearts (for the most part) we pediatric dentists want to help our patients more through prevention than through restorative procedures. Unfortunately, pediatric dentistry has, partially by necessity, become way too focused on restoring a child's mouth.
You’ve undoubtedly heard the question, “Doctor, what can we do about her bad breath?”
Jenny’s mom asked me that question a worried look on her face. “I’ve talked to the pediatrician, and nothing is wrong. But, she is being teased about it, and we notice it at home too. Can you help us?”
And you’ve undoubtedly run through the conventional wisdom of telling them to check with their pediatrician or doctor about any upper airway infections, congestion, allergies, and about any GI tract illness, including GERD -- and be sure they brush and floss well every day.
Past that, you have suggested mouthwash. Maybe.
Mouthwash? Not. A. Good. Idea... because many-to-most mouthwashes have alcohol which dries the oral cavity and may worsen the situation. Of course there are products created for just this situation, the 'BB' (Bad Breath) that embarrasses the patient and/or parents. Those may work, though are often expensive and do not get to the etiology of the problem.
About 25% of the population has chronic BB, apparently not related to the above etiologies. A study of Army recruits found that only 17% did NOT have halitosis.
What could be the reason for BB?
Once you have ruled out the respiratory tract and GI tract (including gingivitis/perio disease) as sources, and the patient’s medical reports do not show other systemic diseases or challenges, the etiology is… GET READY…FOR…IT…
PROBABLY… an unhealthy and highly pathogenic MICROBIOME.
Bad bugs in the gut.
BB (Bad Breath) is caused by BB (bad bugs).
The trillions of microbes we call the microbiome is the community of coexisting microorganisms found in and on the human body. According to studies, the number of microbes is actually from three to ten times the number of cells in the human body. This includes the red blood cells, which are about 25 trillion, or 84% of the total cells of the body.
These microbes include bacteria, fungi and viruses (as well as other simple organisms called archaea and protists (algae and amoebae), that coexist with body cells. They are crucial for the immune system, and for hormonal and metabolic balance. Many are necessary “good bugs” that work with the body for health.
Some are not good. These are the BB (bad bugs), and have been implicated in cardiovascular diseases, cancer, infections, diabetes, Alzheimer’s, even obesity and other serious illnesses.
Everyone routinely carries some pathogens or “bad bugs.” In healthy people, they co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers.
It hasn’t helped that we have become so “germ-conscious” that we’ve overdone it to the point of killing the “good bugs”, and letting the “bad bugs” overgrow. We use anti-bacterial soaps, and disinfecting wipes and lotions. Often more quickly able to "bounce back" from such an attack, the bad bugs have a heyday.
Additionally, nutrition and diet are critical parts of the body’s interaction with its environment, as frequent snacking and high carbohydrates and sugars help the pathogens overtake the friendly microbes.
When out of balance, one of the possible results in a human body is BB - halitosis.
Balancing and restoring the microbiome has the potential to make us much more healthy.
Start with probiotics, the supplemental “good bugs” that are packaged in liquid, capsule and chewable forms. In fact, for the patient with BB, the chewable can be fantastic.
Encourage the patient to reduce the intake of sugars and carbohydrates, on which the “bad bugs” feed, and to chew up three or four probiotic tablets a day. One brand is American Health Chewable tablets, and available on Amazon as well as at many health food stores.
It works! Amazing when we get to the etiology of the problem!
Jenny’s mom reports that she no longer has any problem with BB, now that she is limiting sugar and carbs and using Probiotics. She’s a happy girl! Likewise, no BB for my daughter, one of my assistants and a colleague, all of whom have successfully addressed their microbiome.
Got BB? Get Probiotics!
One of the great myths believed by some pediatric dentists is that they need to avoid extracting baby teeth whenever possible.
For us dentists, we have been guided by a need, a dream, to help others. Going to dental school, and to residency and further training, takes a whole lot of “get-up-and-go” and a whole lot of “stick-to-it-iveness.”
Our schooling and hard work was (and is) driven by our need and dream to help others AND to make a good living for our families and ourselves.
Sound familiar? Then, in practice, you start working, working, working, calling on your “get-up-and-go” and your “stick-to-it-iveness.” You take more continuing education. You believe in education.
You work long hours, after your staff has gone, and sometimes before your staff arrives in the morning. You take time away from your family. For some of us, probably especially us girls, we have the children at the office frequently because that’s where we are. Still, your family time and routines are centered around your job, your practice. After all, it’s how you take care of the family, right?
You do whatever you can for the patients, because you want them to be happy, to like you - to love you - to become part of your “family.” You do whatever you can for your staff because you want them to be happy, to love you, to be part of your “family.” And they are. Often the staff see you as the benevolent “parent” in this purported family. Your immediate family may not see you enough.
And somewhere along the way, it feels all mixed up. Do you feel significant? You feel tired.
Do you feel capable? You feel confused.
Do you make enough money to support your family the way you want? The practice overhead is huge, eating you up.
Do you have enough time with your family? For yourself? Do you feel appreciated, loved?
What is missing in your picture?
Why doesn’t your life work better? Why doesn’t your practice grow?
Because YOU don’t.
How will you solve your dilemma?
The only way is by reinventing your system to solve it.
Start by identifying what is missing. Certainty? Security? Love? Significance? Growth?
Each element or core human need has a corollary that holds you back. Certainty - stability, security, consistency - is hidden by your fear. Fear of what patients, staff, family, even strangers think of you. (Read recent blog, “Way too.”) Fear about your capability.
Love may be hidden by your being too “busy” to notice, to participate. While doing for others is the way you give love, your need for love may be so depleted that there’s not much to give.
Significance may be so hidden by your exhaustion, your need, that you cannot see it. Your life is just way too hard.
And growth? Who has time or energy for growth when you are THIS busy?
What is missing in YOUR picture?
What does the most important person here need? YOU!! What do YOU need?
To solve your dilemma, begin creating a system that will free your time, your energy, your emotion. Believe it or not, growth is what’s needed.
“Wha-a-a?” you say. “How can I have time or energy for more education?”
This education will help you find the tools, the methods, the processes to begin the system that will free you from the whirlwind of your life.
You are too valuable and too wonderful to keep being vulnerable to your fear, your whirlwind and your exhaustion.
Why not now?
Why not you?
Books to read ASAP:
Dalio, Ray, Principles
Gerber, Michael E., The E-Myth Revisited
Baker, Chris, Real
Dentists who treat children often deal with certain fears about their profession. There are some great choices that can "rescue" these dentists from their fears. Dr Chris explains...
The languages dentists have to learn!
Do you-speak 'insurance company-speak'? Do you speak 'parent-speak'? Do you-speak 'child-speak'?
Today I am looking at insurance company-speak.
And btw (by the way - that's 'text-speak') - “corporations” here refer to insurance companies, big box and other corporate dental practice owners, and government entities including Medicaid and Medicare, all of whom skim your money off the top, so you do not get paid what you have earned.
What on earth are you paying them for?
The privilege of keeping some of your money after you spend more money paying staff to file claims for the patient, to wait on hold on the phone for hours, literally, waiting to talk to the “corporations” to evaluate how much of your money they will send to you, file appeals, and then find out the appeal reached the corporation after the “deadline”. Why is there a deadline on getting your money?
I am a dentist, not a provider.
Provider sounds like a waiter.
Provider, they say, as if somebody has to help you do your job.
Provider means anybody can do it – it does not imply many years of school, experience, professionalism, licensing, board examination and wisdom.
“Provider” is insurance-company-speak, just like;
“Usual and customary” - whose usual? whose customary? Not yours, for sure!
“Acceptable” - to whom?
“Estimate of benefits” (EOB) - that is the patient’s benefits - it should have NOTHING to do with you. they are not be YOUR benefits. Because they are not benefits at all, but rather the “spoils” left after the corporations took a lot of your money.
“The network” - a list of doctors whom the corporations have convinced should share their income with the corporations.
“Participants” - see “the network” above
“Network providers” - see “the network” and “participants” above. Amazing how many names you are being called.
“participation” - the act of becoming a “network provider” or “participant” and reaping the losses as you pay the corporations.
“Healthcare” - insurance-speak for disease care; the acts and services of restoring diseased organs in the body, of addressing adverse growth and development, and at disease care’s best, of working to help the patient PREVENT disease and adversities of growth and development.
“Healthcare” is also the name the corporations use for themselves, and not for the practice of medicine that you provide.
As Dr. Paul Henny reminds us, we don’t make health; that is something that cannot be bought by the rich nor given to the poor. It is something the patient maintains and works on and with.
Interestingly, the corporations have successfully made the education of patients and parents as to how they can take responsibility for their health, a “non-reimbursed” “service.” In insurance-speak, this means it looks completely worthless to the corporation and relatively worthless to the patient. This leaves the impression that the doctor who is dedicated to helping the patient learn prevention can just do it for free.
And now, the corporations are taking on the diagnosis of your patient. They are defining what periodontal disease is, for example. (Insurance-speak parameters for periodontal diseases may not even include the presence of calculus, or pockets of a certain depth.)
It’s amazing that an administrator/clerk/bureaucrat working for an insurance company/corporation in another state purports to know your patients’ conditions more than you, even though you’ve been treating the patient for many years.
Think about it - do you really want to continue contributing to the corporation executives’ seven-figure incomes out of your pocket? Do you want to continue working for that?
The story of the frog comes to mind, who finds himself in cool water and doesn’t understand there is a burner under his pot of cool water. As the water gets warmer and warmer, the poor frog doesn’t realize he is being cooked and will soon be dead.
Are you serving yourself and your patients? Or are you serving the corporations? ...and their executives and stockholders? (And some of their CEOs with seven-figure incomes?)
“Choose this day whom you will serve.“ ~ Joshua 24:15
Dr Chris explains one possible challenge with orthodontic finishing.
Dr Chris Baker
Dr. Chris Baker is Past President of the American Orthodontic Society, a pediatric dentist and teacher of orthodontics, An author, dental practice consultant, mentor, and a current or former faculty member of three U.S. dental schools, Dr Chris practices and blogs in beautiful Abu Dhabi, UAE, and glorious Texas, USA.
Text and images
© 2018 Dr Chris Baker