Hampton Cove – Our New Office

Our new Pediatric Dentistry office opens in March 2015 to serve our patients in the Hampton Cove area.

Alabama Pediatric Dental Associates and Orthodontics (APDA) now has four offices: Huntsville, Decatur, Madison, and now Hampton Cove.  I can hardly believe that we have grown so much!  Our doctors plan to rotate to Hampton cove just as we do in our other offices.  We think you will like the nice, high end decor. Although, there is no huge indoor playground like in our larger offices, there is a great video game area for the kids.

Hampton Cove is a suburb of Huntsville, Alabama and for the most part resides within the city limits of Huntsville.  I remember when it was just cotton fields.  Now, there are many homes and a Trent Jones Golf Trail that is one of the best in the Southeast.

So, if your children need a Children’s Dentist (teenagers too), give us a call.
Hampton Cove Office: 256-693-8900
I’ll add some photos here as we begin the process.

The new sign:


AAPD annual meeting in Boston!

The American Academy of Pediatric Dentistry (the aapd) had its annual meeting in Boston last weekend.  This is the annual gathering of pediatric dentists, staff, vendors, family and friends for fun and education.  Most of the meeting is continuing education.  However, we had the opening party at Fenway Park.  I thought, after having last year’s meeting in Orlando, well, they could not match that.  They did, with a great party atmosphere.  Here are a few photos.  By the way, the security guard at the door asked me if I was from Alabama.  He said, “Really? an Alabama hat?”.  He almost didn’t let me go in, but relented with a wry smile on his face.  I said, Roll Tide.  See if you see any familiar New England characters:


Put It Out There For Free

Recently, I was asked to speak on marketing and social media.  Our large group pediatric dentistry and orthodontic practice requires a solid marketing plan to keep the practice healthy.  We actually spend more time that I think we should on what is vaguely called “marketing.”

Seth Godin, guru of the marketing world, a while back recommended aspiring writers to “give away” their first book?  Really? I can see writers saying, “No way.  I spent thousands of hours of effort on this thing to just give it away for free”.  How can this work?  As he explains, you gain a following, you gain (deserved) notoriety as an expert and authority.  Then, when your second book comes out, you have a built-in audience.

We as professionals, usually view with disdain trying to “sell” our services.  We want to spend time on dentistry and patient care.  We are above such pandering.  Still, in the modern marketplace, if you do not let people know who you are, what you do, and that you are accepting and want new patients, your practice will slowly whither away.  This is especially true of practices like Pediatrics and Orthodontics.  Your patients eventually grow up and need to be replaced with younger patients to maintain your practice.

I will not go into great detail on dental practice marketing, that would take several books worth of text and seminars to get all that across.  I will say, the number one way to grow your practice is by giving good service and the word of mouth that is generated from that.  Sometimes, however, that is not enough.  It is obvious that part of our profession is to give of our talents.  We do charity work, do overseas mission trips and work for free at local charity clinics.  There is great value just in that.  I think the general public has no real idea how much free service dentists give away every year, sometimes not by choice, -but I will not get into that here.

What I have tried to do with this blog is inform and entertain.  I don’t earn any money off this blog.  In essence, I give it, the content, away for free.  Why?  Well, first off, I just enjoy informing and educating.  I enjoy writing.  Secondly, in a business and marketing sense, reputation leads to increased business, to increased patients wanting your services.  They know you, they respect you because they know you know your stuff.

Other professionals are doing this and vary from musicians to English tailors.  I follow  a music group called Postmodern Jukebox.  They make music videos and post them online.  They are very good, but offer these online for free.  Now, after gaining notoriety, they are offering their songs on iTunes and are starting an American and European tour.  Another musician, Christopher Bill, a trombone player, makes free videos on his websites.  You may have heard of his version of “Happy.”  He now has an album on iTunes and is well known enough I am sure he is getting offers for paying gigs. An English tailor, Thomas Mahon  long ago began blogging about the inside details of his profession.  He now has a thriving business.

All these professionals offered the public something for free.  If anyone wanted to used their paid services, they were certainly welcome to do so, and many have.

So, if you are getting frustrated with your practice marketing, consider offering to be a speaker, offer seminars, blog, write, do online videos—all for free.  Now people can tell if your love it or not, if it is a chore or not.  In the process, you may actually help people.  You will help yourself as well through the process of creating content.  If you show your passion, it will show and return to you in time.


Sign This

While at the hospital the other day, I was asked once again to sign some paperwork for the hospital before being able to see one of our patients in the OR.  Each time there seems to be a new form.

For physicians, dentists, and about everyone else, it appears there is more and more paperwork to be filled out, signed and filed away every day.  Regulations and documentation requirements are taking more and more of a doctor’s time.  In fact, in one recent study, physicians cited electronic medical records (EMRs) as their greatest source of frustration.

Insurance coverage is changing continually as people loose their coverage and obtain new policies.  A good deal of documentation does tend to address patients needs, but seldom generates revenue.  It takes time, and time is money.  Thus, paperwork and the time it takes to properly complete, is one of the many causes of the rising cost of medical and dental care.

1.  JACO  -Hospital regulations.  Every now and then I see the hospital staff with a worried, frenzied look on their faces.  Is it a patient issue?  No, it’s an upcoming JACO review.  Everything has to be in order; signed, filed out, ordered in the approved way.

2.  Obamacare.  Massive increase in disclosure, paperwork, and especially insurance changes, causing many people to loose their coverage, then get new, often confusing coverage.  These changes are nightmares for the front office staff of medical and yes, many dental offices.  Some people have pediatric dental coverage rolled into their new health plan.  Some often get family dental plans to supplement the adults in the family, causing a double-coverage situation for the kids.  There are very large deductibles.  Many doctors are not signed up as “providers” for these new plans.  Confusion is common.  By the way,  I dislike the term “providers”.  Insurance companies and government bureaucrats created the term for their own purposes.

3.  Liability.   There is always the need to document everything to limit liability.  Some documentation is good for patient safety, but some is unrelated to actual care.

4.  Recent requirements for electronic medical records create a situation where your doctor may be looking at a computer screen writing down your symptoms rather than actually looking at you during your conversation.  Some doctors have to hire additional staff to handle the additional dictations, recordings, filings, and well, paperwork.

I have to go now, they want me to sign another form……


Teething Troubles

As a Pediatric Dentist, I see patients from birth to age twenty-one.  In one chair there may be a college age teen who needs his wisdom teeth removed, and in the next, an eight month old with new teeth just coming in.  Yes, we see such young babies.  It is important to have the first visit to the dentist by age one or within six months after the first tooth erupts to establish preventive strategies and make sure dental development is progressing normally.
What concerns many parents are the teething problems associated with the erupting baby teeth.  As the new tooth gets closer to the surface, the gum thins out and you often can see the new tooth bulging right under the thin gum tissue.  Eventually, the gum opens up and the gentile eruptive force of the new tooth moves the tooth up into the mouth. 
When do the teeth come in?  Well, that varies a lot from child to child.  Typically, you might expect the first baby tooth to come in around 6 months of age.*  I see as early as three months and many who are one year of age who don’t yet have their first tooth.  There are actually some kids who are born with a tooth already in place!  The first tooth to come in is typically the lower front incisor.  After that, the order varies with the front four upper and lower teeth coming in first, then the first molars in the back around one year of age or so.  Again, there is a lot of variability.  If you are concerned about any delay, see your Pediatric Dentist.
Does teething usually cause discomfort?  Most of the time babies do not complain much at all when getting their new teeth.  There are, however, times when there are the typical symptoms of teething discomfort.  Many children will begin to drool more than usual.  It’s normal for babies to put things in their mouth exploring textures, but they may want to chew objects a little more than usual to massage the sore gum areas.  They may be grumpy, become more agitated than usual, or even run a slight fever. Mild diarrhea the day the tooth comes in is not unusual.  Constant or severe diarrhea is not normal and should be evaluated by the pediatrician.
Is fever normal with teething?  Now I caution parents to not be too quick to blame a high fever on teething.  New teeth erupting can cause a slightly elevated temperature.  A fever of one hundred or higher should always be looked at with concern as young children are also susceptible to a myriad of conditions that can also cause a fever.  Ear infections are a very common cause of high fevers in babies.  I occasionally see young children with a high fever, multiple oral ulcers who are not eating and are pretty much miserable.  This is not teething, this is an infection caused by the same virus that causes cold sores.  There are many other infections and conditions that can cause a baby to drool, complain and have a high fever, so consult your pediatrician if the fever gets high, or if you are just not sure.
What can you do to relieve any discomfort?  I suggest using cold teething rings or something soft (and safe) so they can chew and help them to feel better.  There is some concern recently about the liberal use of Baby Oragel.  This is the cream with benzocaine, a topical anesthetic that numbs the immediate area when placed on the gums.  I have not seen any definitive study that would cause any concern so long as you use it in a limited manner.  Place a small amount on the gums where the tooth is erupting to provide temporary relief.  Tylenol is ok in appropriate dosages if the child is particularly grumpy or has a low-grade fever; but again, do not dismiss a high fever as just teething.

The American Academy Of Pediatric Dentistry’s Annual meeting

The American Academy of Pediatric Dentistry (the AAPD) met in Orlando this year.  I’ve been told an Orlando meeting is the most registered for, least attended meeting the AAPD schedules.  This year there were about 6500 people in attendance.

I was privileged to be asked to judge the annual poster competition.  These are presentations of research projects done typically by pediatric dental residents.  These presentations covered, trauma, oral pathology, orthodontics, sedation and general anesthesia, insurance, Medicaid etc.  Most were very well done and I learned a lot just being a judge.

Here a couple of photos taken with my iPhone (so they are not ideal lighting conditions.) They used an iPad to control the big screen plasma or projector image.  That was a nice use of that technology as they could expand or zoom in on desired items or photos.

In addition to the academic seminars, lectures, and academic presentations, there was some nice benefits to having the meeting in Orlando.  Here we are being welcomed into Disney’s Hollywood Studios.  We (the AAPD), had exclusive use of the park that night.  They had a band, fireworks, no-line waits for rides such as Tower of Terror and Toy Story Mania.  The best part was the red carpet welcome:

When will my child loose his first tooth?

I get this question all the time:  When will my child’s first baby tooth fall out?  The answer is that it varies form child to child.  There are a lot of children who are really excited to get a loose tooth.  Their friends are loosing theirs, why not them?

Generally, if a child got his first tooth at an early age as a baby, he will loose it at an earlier age as well.  If he got his first tooth a little late, then he will loose his first tooth later than most.

The typical age to loose the first baby tooth is 6 years of age.  About 90% of kids loose their first tooth at age five or six.

The first tooth to be lost is almost always one of the mandibular (bottom) front central incisors.

If you look at a chart of tooth exfoliation from the ADA, you will see they list the lower front central incisor as falling out around 6 to 7 years of age.  That’s pretty normal, however, I see lots of 5 year old kids with their first loose tooth.  If I’m making a chart, I’m putting 5-6 rather than 6-7.  I see just a few children loosing their first tooth at age 4, and there are many that do not loose a tooth till age seven.  There are a few loosing a tooth age eight, but that’s definitely on the late side.  They key is that it varies a lot.  Four is definitely early, seven or above is later than most, but it’s all normal.  If you are not sure, ask your pediatric dentist if your child’s eruption pattern is right on track.  Also, some baby teeth do not fall out till age 12 on average.

There are a few syndromes or medical reasons for delayed eruption, but that’s pretty rare.

See here for something that happens often:

Permanent tooth coming in behind baby teeth

In case you were wondering , the first baby tooth usually comes in any where from 4 to 12 months of age; usually 6 months of age is average.  This varies a lot as well.


Data Analysis, or Gambling?

I just got back from a continuing education meeting which happened to be located in Las Vegas. I also watched the movie “21” which is based on the real life story of a group of MIT students who learned how to count cards and beat the casinos at blackjack.  They made millions.  They did not let the emotion of the moment influence their decisions.  They used simple math, counting the cards already dealt to increase their chances of a winning bet: data analysis and rather fast arithmetic.

How much of dentistry is pure data analytics and how much is gut instinct?  Well, there are two ways to look at it. First, is cold science, numbers, and analytical data analysis.  We do a clinical exam, we look at x-rays, perform diagnostic tests, ask questions.  We consult the published research.  In medicine and dentistry this might be likened to flow chart decision making, or to something called evidence based science.  We use experiments, data and facts to decide the most likely outcomes.  If we don’t, we are just guessing.

Second, there is the theory that real world experience makes the difference, raw talent, esthetic sense, gut instinct.  This is actually backed up by the study that mastery comes about with many hours of practice, error, corrections, and well, experience.  The more you have done something, the better you are at accomplishing the task at the level of a master, the expert.

My analysis is that they both matter.  You have to make decisions based on real science and study of the available data.  Dentists spend four to ten years after college in graduate education and training in science and techniques. Then, there are years of continuing education classes after that.  Collect the facts, the data, analyze, compare, then decide, act.  The problem with dentistry and medicine is that there is always a lot of data that is not knowable, that is missing or not timely.  That is where experience comes into play.  That is, making decisions when you do not have all the data you would like to have.  Sometimes there is more than one appropriate option.  Whether we like it or not, there is a lot of emotion involved.  Sometimes you go on experience and gut instinct.  Count the cards if you can, but sometimes you develop senses that tell you the card count at a subconscious level.  I’d like to think going to the dentist is not a gamble, but as close to a sure thing as you can get.


How To Keep Your Child’s Teeth Healthy

Here is an article based on an interview with Dr. Joel Berg, pediatric dentist and president of the American Academy of Pediatric Dentistry, discussing prevention of dental disease in children.  Basically, he lists five things: start dental visits early, eat healthy, care for baby teeth, model good habits, and make it fun.


The Cost Of Braces Is Going Up?

There are a lot of factors that go into the cost of providing braces.  First, and significantly, it is the diagnostic and technical expertise of the orthodontist.  Try doing braces yourself and you will not likely get the same result.  Secondly, it is the overhead of the orthodontic staff, facilities and associated office costs.  Finally, it is the actual hardware itself, that is, the brackets, wires, adhesives and attachments.  These items are often made of sophisticated metal alloys such as nickel titanium that are manufactured within precise tolerances.  There are laboratory fees as well for diagnostic models or services.  So, as the cost of salaries, health care coverage, utilities, and supplies go up, so does the cost of braces.

Recently, there is another factor, which will increase the cost of providing orthodontic treatment.  That is the new tax that is part of the new Obamacare health care plan.  There is a new 2.3% medical device tax.  Yes, that cost will likely add up to at least $175 more than the present fee.