Lakeside Dental: The State of the Union
On Wednesday, July 19, my governing body, the RCDSO (Royal College of Dental Surgeons of Ontario) released an advisory that Covid-19 specific guidance is no longer in effect. This means that dentistry returns to the very high level of care that was available prior to March of 2020, but without the extra steps that controlling the Covid pandemic required. For you, this means that masks are no longer required by patients or staff in non-clinical areas of the office (our reception area and waiting room). A nice return to normal.
It is interesting to note that in the first 18 months of the pandemic, when things were most out of control, there were zero reported cases of Covid transmission between patients and staff in dental offices in Ontario. The measures that were put in place probably went beyond what was required, but we really didn’t know, and they were indeed successful.
I got my case of Covid from the grandchildren of a close friend. I was fully vaccinated, and it was about as severe as the third worst cold that I have had. On the other hand, I am aware of the Covid-related deaths of several people in my extended group of family and acquaintances. This was not a trivial event.
The State of the Union
Having said all of that, I thought that this would be an appropriate time for a “State of the Union Address” to those of you who see us here at Lakeside Dental. The State of the Union Address is an annual message delivered by the president of the United States to a joint session of the United States Congress on the current condition of the nation. So, bearing in mind that I am a dentist practising in his home on a side street in Port Dalhousie, I thought that I should discuss, with you, those people coming to us for care, the state and future directions of our practice.
I’m occasionally asked when I’m going to retire. The answer: not anytime soon, I hope.
If I could wave my (imaginary) magic wand, knowing that I would expire exactly 20 years from today, what would I change about my life? Exactly nothing!
For me, I am (currently) living an almost perfect life. I retired from dentistry 15 years ago and then, after some thought, took up a retirement project: Dentistry: in my home.
I indulge myself in my retirement project 3 days a week. Nice people (you folks) come to see me with interesting problems and I get to solve them. I look forward to Mondays, because I can get my brain fully engaged, and I look forward to Wednesday afternoons, because I can stop thinking so hard.
My work environment is great: I have 2 excellent and thoughtful support staff (Edith and Jennifer) that have been with me in this office for 15 years (along with other outstanding background and support staff). Our one dental chair is centred behind a 14-foot bay window that looks out over my gardens and Lake Ontario. We get to watch the seasons: spring, summer and then the descent into cold and darkness (unlike many, this writer actually enjoys the great Canadian winter). We see wonderful winter storms and then sailboats and surfboarders (who knew: Great Lakes surfers!) in summer. Since I work in my home, the result is that I have one of the great private offices, complete with a wood stove, a fully equipped kitchen and a dog. Commute times are manageable. Being one’s own boss is also very useful in this equation.
When Should One Stop?
Canadian born architect Frank Gehry, designer of the Bilbao Guggenheim Museum in Spain, described as “the most important architect of our age”, felt that at the age of 93 he still had a lot to get done and had no interest at all in winding down.
About 10 years ago there was a 92 year old dentist in Toronto who was working 5 days a week. He was still purchasing new equipment. He worked with his son. His son was 70.
A few years back, my mother called me and said, “David: I’m 94 and I’m running 2 miles a day 5 days a week: I think that this is too much.” I replied that she was old enough to make her own decisions. She agreed and began walking instead of running.
Between the track record of some of my heroes, and some genetics that hopefully came my way, I am given hope that things will continue as they have in the past for some long time to come. However, as my good Moroccan friend Brahim says: “Inshallah,” if God wills.
Unlike many occupations, I have enormous control over my life: I choose how many days I want to work, how much time I need off and what I do. Many occupations involve unpleasant or unsatisfying work. Many occupations are full time or nothing. If this was the case, I would stop doing what I am doing. It’s not. I get great satisfaction from resolving complex situations for appreciative people. And I get to do it on my terms. My life will not be better once I have to stop.
In my old office, with 5 chairs and 12 staff, we ran a good show. We were patient focused and it was a good physical environment. However, it was all a balancing act: with 12 staff office politics take some significant thinking about. Because we had 2 or even 3 hygienists, I was regularly interrupted to do checkups for my hygienists’ patients. When doing a long, intricate procedure, this meant leaving the patient one or more times and then returning and refocusing. This was frustrating and tiring. Our patients weren’t always impressed either.
At the office in Virgil we worked 4 days a week. Occasionally, when I had a large or complex case, we would come in on a Friday with the person coming for care and one assistant. No-one else was there. The office was quiet. There were no distractions. From beginning to end I was uninterrupted. It was peaceful and deeply satisfying: I didn’t feel like I was actually working.
When St. Catharines changed its by-laws to allow home medical/dental offices back in the early 1990’s, I envisioned a one-chair dental office on the second floor replacing my wood-working shop. We now have that: an unhurried environment where we can undertake treatment without pressure and with almost no interruptions. This feels like a privilege.
Interestingly, Edith and Jennifer, who have worked in other dental settings, both feel exactly the same way. It’s an unusual model, but works remarkably well: both for us, and, we are regularly told, for you.
I have colleagues who, for health reasons, have had to withdraw from dentistry in their 60s and even 50s. In physical terms dentistry requires, among other things, good eyesight, a good back, steady hands and a decent brain. All of these things are working for me, I’m taking no medications and I seem to have inherited some of my mother’s better genes. So, until something lets go, I have no intention of changing anything.
Other Thoughts
Optics: when I was a young dentist magnifying loupes were essentially unheard of. The light came from an overhead lamp. The tooth was, in retrospect, a distant, poorly illuminated focus of attention.
Today we have loupes with enormous magnification and a brilliant light source placed between the loupes. There are no shadows and the tooth occupies most of my field of vision. Loupes took some getting used to, but once accommodated, there was no going back. Everything is so much clearer and easier. I benefit, and you, the patient, benefits.
Perspective: Back in 1970 I applied to the two dental schools in Ontario: University of Toronto and University of Western Ontario (Interestingly I didn’t apply to the program at Dalhousie University in Halifax because they wanted $5 with the application. That seemed completely unreasonable. Different times... I was accepted by both and decided on Western: I’m not a bright lights and big city kind of guy. I started in the fall of 1971 and graduated in June of 1975. I am amazed at how far things have come since then.
I mentioned optics above. We placed our last silver-mercury amalgam filling in 1992: the recent discovery of dentin bonding allowed tooth coloured fillings to be placed reliably, permanently and with far less sensitivity. Crown materials were a choice between gold (unsightly and expensive) and porcelain (weak and abrasive to opposing teeth). We now have zirconium oxide: a sort of wonder material: enormously strong, non-abrasive and tooth coloured. The treatment of periodontal (gum) disease has gone from a mysterious, little understood, and failure prone set of procedures that focused largely on surgery, to clear scientifically driven therapies that have a much, much higher success rate than in those earlier days. Dental implants, a replacement for missing teeth, have evolved from being a distant dream, to a problematic, failure-prone procedure to, today, a very successful and essentially permanent technique. (Not inexpensive, but amazing)
All of this on-going improvement requires much continuing education. Dentistry (along with all health sciences) is blessed with an abundance of lectures, study clubs and computer based information and updating sources. This was not always the case and the transfer of knowledge, from science to practice, occurred at a much slower rate.
When I first set up practice in Niagara in 1976 the area had (aside from oral surgeons and orthodontists) almost no specialists. The result was that a general dentist had to take on a broad range of responsibilities. Things have evolved: we have specialized excellence in children’s care (paedodontists), root canal therapy (endodontists) and gum disease therapy (periodontists). We even have a specialist in dental medicine, a field that didn’t exist when I graduated. As a result, when things get interesting/complicated, there is a higher authority that one can turn to.
Newsletters: Prior to Covid we put out a mostly annual newsletter: half narrative and half dealing with dentistry. I got started on one when the pandemic hit, and it got put on hold. Once summer ends it may well see the light of day. It’s a reflection on Georgian Bay, its history and my involvement with it.
Referrals
We are often asked if we are we taking new patients? Yes, we are.
When we see a person for the first time we have 2 goals: the first is to restore good dental health and the second is to provide a high level of understanding of prevention so that we largely aren’t needed again. At this point we have room for someone else in our schedule.
So: yes, we appreciate the referrals that we receive from you. Being busy is good.
Second Opinions
We regularly have requests for a second opinion regarding a course of dental treatment. One benefit to having been around for a while is one gets a sense of what works and how things will turn out. We enjoy these requests for guidance, and in most cases, don’t even charge for our counselling.
A Final Thought
Victor Frankl: Austrian psychiatrist, holocaust survivor and author of “Man’s Search for Meaning” once posited that “Happiness is the unintended consequence of meaningful activity.”
Think about this slowly: looking for happiness directly doesn’t really work: but if you structure your life so that you are doing something that is meaningful, happiness will tend to find you and settle in around you.
There are a number of things in my life that qualify: being a good grandparent, being a part of a number of communities and cooking well, these are all meaningful. So is being a dentist here on the edge of Lake Ontario: nice people come to see me with interesting problems and I get to solve them. This is meaningful: and my life will be less good once I am no longer able to do this.
So ends the “State of the Union Address”.
David Bergen (and staff)