So, I figured I would spend my blog this week discussing a term that it now becoming common place in the discussion of disease process and that term is Biofilm. Initially, cavities (actually an infectious disease) and gum disease (also infectious) were thought to be caused by bacteria (and the science behind what bacteria is too much to go over here). In the last several years the concept of biofilm has come to the forefront of what causes dental disease. And once you understand biofilm you might understand why it is a lot harder to beat that just plain old bacteria in your mouth.

Biofilm is, according a one dictionary, a thin, slimy film of bacteria that adheres to a surface. In dentistry we deal primarily with two different biofilms, ones that adhere to tooth surface ( and are primarily responsible for cavities) and biofilms in the gum tissue pockets (responsible for gum disease). The problem with fighting biofilms is that bacteria in biofilms do not act the same way as individual (planktonic) bacteria do.

Traditionally, bacteria were studied on petri dishes in the lab, where you could grow an entire colony of an individual bacteria…and then you could see how medications, like antibiotics, affected the colony of bacteria. Easy…..

But biofilms change all of that because bacteria behave differently in biofilms than they do as individuals, they mutate quicker, become strong allies of other bacteria, and develop different abilities than planktonic bacteria. Researches have even found that there are over 30 different bacteria, that when studied as planktonic bacteria DO NOT react with sugar to demineralize teeth and cause cavities but when they are in acidic biofilms THEY DO cause cavities. The biofilms make these seemingly benign bacteria become teeth killers.

In my office I often give the analogy that studying individual bacteria colonies is like putting a mop handle in the middle of the desert in the sand……. not too hard to pull it out. But if you would bury that mop under a garage building in the middle of a downtown Manhattan block and it would be pretty hard to get the mop out. That is one bacteria living in a biofilm of Manhattan.

The biofilm on teeth present an even more unusual challenge to fight. The tooth, which in some ways is the hardest substance in the human body, does not shed its outer layer of cells like skin does for an example. This allows the biofilm on teeth to become more mature than other biofilms making it even HARDER to fight.

And because of the nature of the slime that maintains the biofilm, it is very hard to eliminate the biofilm when treating gum disease. That is why it is said that you never eliminate gum disease, you only control it.

There is good news on the horizon for patients who are really interested in fighting the biofilms that infect their mouths. There is the CariFree system to help fight the biofilm that causes cavities and there is PerioProtect, another system specifically designed to help fight the biofilm of gum disease.

If you are tired of always dealing with getting new cavities (the results of the infection) and bleeding gums there are tools to help you…..Just ask.

Fran suggested a book for me to read, the Five Love Languages by a Dr. Gary Chapman. Well, being someone who has so much to do I went ahead and got it on MPs so I could listen to it on the commute to and from work. It was very easy to listen to and it was about the different ways people want to hear “I Love You”, but in reality it can be about every relationship you have. I kinda always knew my main language was that of affirmation. (This is a new concept for me in the sense that I used to think it was wrong to have a high “Needs Approval” as a personality trait).

There are many ways in my practicing of dentistry that I can get affirmations left and right. “That didn’t hurt at all”, “That crown looks just like my own tooth” and on and on. And they are all very important to me since it is my desire to provide the most esthetic dentistry in an environment that fosters mutual trust and respect.

If you know about my passion for prevention and my belief that the best dentistry is no dentistry then you would not be surprised to find out that perhaps my favorite affirmation of all in the office is when my patients get what taking care of their mouth at home is all about. And not once this past week, but twice, was I fortunate to have the feedback that makes me feel that I am actually making a difference.

The first time came from a new patient, a woman in her middle age, who when she first came to the office about 6 months ago had gum disease. With the help of the hygienists in our office, this woman went ahead with treatment meant to help get her gum tissues healthy. This in itself is not unusual. What is unusual is how a woman, who for the better part of her life never really took care of her teeth, got it because we tooth the time to teach her. And the payoff is how much she says she feels better because she is doing what she has to do, and how her long term costs are going to spiral downward because she is taking care of her mouth. And she sat and credited our office for her shift in her ou look for her own dental health.
The second affirmation is just a little second hand story…but it is still my favorite type of success story in my office…because it involves a young patient, an 11 year old girl, who I had only met once in the office. Her mother was in and she told me that what I ever I had said to her daughter impacted her so much that she has been flossing her teeth religiously since her exam and hygiene in the office.

Doesn’t seem like much but to me our office has greatly impacted these two patients in a way that should help them for the rest of their lives. I can’t speak for any other dentists in the world, but for me this is the true purpose that I was put on earth form to help people. Not just in my office but in ways that impact them for the rest of their lives. That’s what it’s all about.

I don’t know about you but in my mind the ability to run is an indication of relative health. And it is becoming an even bigger passion of mine…trying to stay healthy.
And once again I have to remind myself that as much as I would like to make tons of changes all at once I really have to go with just a few at a time.

One of my favorite magazines is Men’s Health. There are pages that have single to several paragraph snippets of advice, any of which I could follow and improve my health. I also get their daily emails with all sorts of ideas of how to improve my diet and fitness tips. About a month ago I started doing one of the exercise routines they posted online. I start by doing 10 pushups and then 1 full body squat. I immediately do 9 pushups followed by 2 squats. You get the picture, by the time I am done I have done 55 pushups and 55 squats. I do this 3 times a week and I know it sounds crazy but I can already see the physical changes. At the ripe age of 53 this makes me feel like I did in high school when I did a lot of weight lifting.

I just finished watching Dr. Robert Lustig’s most currently posted lecture on the evils of sugar. It is called Sugar: The Bitter Truth and he just breaks it down so well as to why sugar is root of the obesity issue facing not only the United States, but the entire world. (Brazil, an emerging economy has had the highest percent increase of obesity and diabetes in the world the last few years). And as he sees it whether it is sugar or high fructose corn syrup it is the same poison. Even worse, if you look at what criteria makes a substance become an addiction….Sugar fits the bill so it is safe to say our bodies are getting addicted to sugar at an alarming rate.

Where am I going with this…simple. If you drink a serving of a sugary beverage (and that is 8 ounces….not the new 20 ounce soft drink bottles) and you don’t need those calories you would drink 15.5 pounds of fat a year. The problem is that the average kid is drinking 4 servings a day. It is no wonder we face an obesity epidemic in health care that has caused our premiums to go up over 50% to treat.

My strong recommendation for one of the quickest ways to start improving your health is to eliminate sugary drinks from your diet (and this includes fruit juices which are mostly sugar). Water, coffee, tea and milk are great choices. And guess what? Your chances of getting cavities may be greatly reduced as well.

Don’t take my word for it…go look at the video on YouTube yourself. And then see if Dr. Lustig makes sense. And then you can start making choices so that

LONG MAY YOU RUN

Just because I am a health care provider does not mean that I am any less immune to the difficulties in navigating the world of health insurance.

I have to shop quotes like everyone else. It is impossible to really tell the difference between plans and trying to find the best value for the type of care that I want for my family. And just like you my rates go up every year, my benefits usually go down…..the same stuff that frustrates many of you.

And while it has been easier for me to see the glass more half full than half empty (as of late (thanks to all my family and friends for that) I do not have a particularly rosy picture of healthcare in the future. The trends have been set…even with all the changes the government is promising. It is a basic scale of economy…there has to be cutbacks in some of the care we are going to get. It can be in the quantity or quality of service, but there will be changes.

While I was at the Careerfusion meeting in Florida it kept coming to me what the real answer for the best health insurance is in this country. It will save you and me tons of money in the long run. It is you, it is me. It is called personal responsibility.

Personal responsibility can mean different things to different people. I am guessing that for one obese celebrity chef, her idea of personal responsibility was for her to make a financial gain endorsing a diabetes drug as opposed to trying to change her lifestyle and educating the public after being diagnoses with the disease. I just don’t think that there will be many opportunities for any of us to monetize anything like that in our lives.

For me, personal responsibility means actually trying to do the best I can for myself and trying to limit how much I must depend on the health care system to fix me if and when I ever break down. (WHY DO WE CALL IT HEALTH CARE..ISN’T IT ACTUALLY SICK CARE)

I know it is hard, trust me I am not genius or even close to being a pioneer when it comes to trying to take care of myself. For many years I knew that I should change my eating habits, but it wasn’t until I saw Sugar: The Bitter Truth on YouTube did I actually get inspired to change my diet.

There are so many things that get in the ways of us taking personal responsibility for our health. Perhaps the greatest reason might be ignorance. But certainly after ignorance it would be an actually desire to make a change. Trust me, as a dentist I can attest to how hard it is to get people to make changes that would benefit them….I mean, why can’t everyone just brush and floss their teeth and eliminate gum disease and cavities.

To steal from a famous organization….easy does it. What I have found that has worked for me is not trying to promise myself the moon when I want to make changes. I try to take baby steps and add a little to each step when the time is appropriate. I just can’t handle trying to make 10 changes all at once. Last year I changed my workout schedule and stopped drinking diet soda once and for all. This year my first two commitments to change were to stretch better and eat way more vegetables than I had in the past.

So why do I write that I don’t want to be a commodity any more. Simple, I don’t know if the public sees health care as a product or a service any more. Unfortunately I see the trend towards viewing healthcare as a commodity (example…. I can’t go to the dentist because I don’t have dental insurance) Even though I know health insurance is a necessary evil in our life I want to try and minimize how much I have to depend on the system to keep me going. Because when I do depend on it I have become nothing more than a commodity in the eyes of the healthcare system.

Alas, I needed a little help so I reached out to a super hygienist/lecturer that I had met, one Shirley Gutkowski, for some help and she told me that I should attend the CAREERfusion meeting in Florida. It was a meeting where one could find other opportunities outside of pure clinical practice to expand their dental horizons. But, here was the catch….I was the first dentist ever to attend this seminar, nothing but hygienists.

Ok, I was a little apprehensive at first, I mean, the only person I knew at the meeting was Shirley and I had only met her at the World Congress of Minimally Invasive Dentistry. But this 4 ½ day meeting turned out to be probably the best seminar I have ever attended in dentistry.

The information was the most pertinent that I had heard in a long time. The organization of the meeting was carefully done and had dental education interspersed with personal growth and development (the growth and development I did not expect and it was very enlightening)

But what really blew me away was the level of warmth and genuine concern that everyone had for one another. I have never had anything like this happen to me before. When I got back home to the office I realized that the best analogy I could give was that for 4 ½ days I was in the womb of a loving dental community of outside the box dental professionals and when I got home I had been given birth to some new directions in dentistry for me to pursue.

I found I had a new level of appreciation for hygienists (not that I don’t already appreciate the three great ones that work with me in our office) but I also came to a very important conclusion about our national health care systems. There is only one true prevention based health care model in the country today and it is the dental prevention/hygiene system of dentistry. It really is perfect, its people that are screwing it up. .But if you take care of your mouth at home, listen to your hygienist and have your recare at the interval that is appropriate for you, you will be healthier, your medical costs will be less and you can keep your teeth a lifetime.

So what am I the world’s dental expert at. That’s easy; I am the first dentist to go to CAREERfusion so I am the dentist expert on the field. And you know what; I already paid for next year so I will be there again, to continue being the expert on it. The picture is from one of the exercises one night…Karaoke night.

AND TO ALL YOU LADIES WHO GAVE ME YOUR FRIENDSHIP AND SUPPORT, WHO MADE MY EXPERIENCE SO INCREDIBLE ALL I CAN SAY IN THANK YOU A HUNDRED TIMES OVER.

This year it was real quiet, just the dogs and us. I don’t know why but after picking up our sushi for dinner I got a idea for a movie to watch on Netflix…an older favorite of ours, Notting Hill. I told my wife what I picked out would be a surprise and once she saw what it was it was happy eating and movie watching.

Now, I don’t know about you, but there is something special about the way that Julia Roberts acts that I don’t get from many other actresses or actors for that matter. I have noticed it in several films and it is she really gets me to understand what she is feeling in certain scenes whether it be fear, love or apprehension. All I can tell you is that she got it all in Notting Hill and I was really happy to see it again.

Here is my wife’s funny reflection on this New Year. Notting Hill was filmed in 1999. There were so many scenes that would have been different today because of the changes of technology and it has only been a decade. The use of cell phones did not exist in the movie and the publicity was all driven by the newspaper media. Today, the movie would have to be so different because cell phone cameras would keep the public aware of every step Julia Robert’s character would have made and then blasted it over the internet.

So, as we enter 2101 it is clear that the changes affecting society are occurring even faster than they did a decade ago. Our knowledge about health and the relationship of the mouth to our individual health has grown tremendously. (Yup…got to get that link into health since that’s what I do). Our choices are do we keep doing what we have done in the past (and get the same result) or do we start embracing the change, incorporate into our lives and move forward with different results.

My personal quest is to keep moving forward, to do more to improve my own individual health. From a business standpoint it is all about how I educate my patients better about all the great advances in preventive dentistry (which leads to better health and lower health care costs). And from a social standpoint what do I need to do to try and make a difference in someone’s life….

I am really proud of the fact that I am a member of the board of the Hollywood Wilshire YMCA. They do so much for their community and in particular the kids. They have program in multiple grade schools to help with after school exercise and education about personal responsibility and health. And in support of our Local Y and their efforts to improve our community our office is now offering the YMCA prescription card.

It’s free to you with NO expiration date. It provides you with up to 80% off of retail prices of prescriptions. It’s accepted at over 61,000 national and regional pharmacies including all major chains (even if their name is not on the card like Rite-Aid). You can use it even if you have medical insurance and see if it is a better price or not. And here is the good news, if you do use it there is a small contribution made to the YMCA for every prescription filled. Call our office to get your card today.

Well, it seems like another year has just slipped by. So much has gone on in the world over the last year that sometimes it just seems overwhelming, at least that is how I feel. Sometimes I just want to shake someone by their shoulders and say to them….Are you kidding me? It’ is at times like these that I remember all the coaching I have gotten from family, friends and professionals….I can only be responsible for that I do, say and think. Seems simple…but not always. I still want to extend my gratitude to all of those who have worked with me over this past year and the many before.

During the past few weeks I have heard so many people complain that customer service is gone, that people are not polite (ever drive the streets of Los Angeles…this might be an understatement here), I even had one patient tell me that over the last 10 years he has lived in Los Angeles he feels like the people have just gotten downright ANGRY.

Well, I certainly hope that the patients at our dental office don’t feel that way. In fact, we encourage our patients to give us reviews after their visits via a multiple of different avenues. But what I want to write about is probably the last customer experience that I will be having this year..at Dan Tana’s restaurant in West Hollywood.

I don’t know why I have never been there before; certainly I have had many people tell me about it. My family and my mother went there for what would have been her 58th wedding anniversary, but her first without my father. We had an early dinner reservation, at 6:30, so it was somewhat empty when arrived. What I noticed when we walked in was that it was not as big as I thought it was, in fact, it was cozy. The Maître De, Christian, took us to our table and then all the fun started.

The waiter had a sense of humor that I have not had the chance to experience in a restaurant in a long time, something that made us feel he had been employed there for a long time. My wife asked him if they had any blue cheese stuffed olives and he told us no. But when the drinks arrived he told us he taken matters into his own hand and viola…there were the blue cheese stuffed olives

The banter between the waiter and us got to a point that he was calling my son sweetheart and my son, with his own sense of humor, was calling him honey. And the while excellent service with our waiter bringing us more than we asked for at every turn. And the food was just as good.

By the end of the dinner the place was packed, full of life and character that the likes we have not experienced at all lately. All of us were in agreement that it was just a great experience…..one that we wanted to have again. And we will.

But what I took out of our dinner at Dan Tana’s was…..service is not dead in Los Angeles, and when you find it…that’s where you want to be.

Happy New Year to one and all.