Blogs From Our Hartsdale, New York Cosmetic Dental Practice
At Hartsdale Dental Care, we believe in creating a relationship with our patients that goes beyond the office doors. We've specially created this section of our site to share with you important dental questions.
Dr. Andrew Woo
How important is technologie to a patient when you choose dentist? Acutally, it is not much important as most patient thinks. Definitely, technology is important and updated equipment is almost basic needs at the dental office. But machine's role stops there.
Good news is younger dentist out of dental school already knows all the newest technolgy and gadgets that can be fine for 10 years out of school. Often, dentist doesn't even know any orther way to do dentistry than the new techique. It is like young people don't know/care about stick shift to drvie the car.
As someone famous said, technology is always on the verge of breakthrough but never will substitute the human being. Ever since childhood, I am marveled at the technological advances and technoloy
Nowsdays, it is not hard to find a dental machine that cost 100,000 dollar. Company claims that the technology will deliver superior results. However, often it end up with disappointing results. Results are not as superb as company claims to be. It is just substitute for another. It certainly doesn't make good dentist out of bad dentist.
I am not a medical doctor. But I have a hunch that all those robotic surgeries and machines has its own problems and limitations.
"What is this deep cleaning business is about? It seems so unnatural to me!" That is what I hear all the time. When a dentist recommends deep cleaning to a patient, it means that the person might have gum disease. The dentist can tell you how often you should get the treatment. I still have to yet meet a person who doesn't want to save their teeth as long as you can. Yet, when I tell my patient that the tooth is hopeless and needs to pull out, often patient ask me back. "Is there any way that I can save it instead of pulling?" Well. . . There is no way to save that tooth, but you can save the rest of the teeth by getting the deep cleaning. By the way, deep cleaning is not really correct term. It should be called non-surgical active periodental therapy.
I had a patient knocking on my door, who wanted cleaning appointment as soon as possible. As I sat down with her and talking with her, she said, "I had a death sentence in teeth." I said, "Surely you are joking, aren't you? There is no death sentence in dentistry! She said, yes. I went to the best dental clinic (Seoul National University Hospital Dental Clinic) and the denist told me the death sentence to my teeth. They said, why bother to get treatment. Just enjoy for a while and pull all of your teeth and get a denture. . . She then decided that was not acceptable. That was the turning point in her life. She carries brush and floss everywhere and anywhere. She never miss four month checkup and cleaning. That is why when she came from San Francisco for taking care of her daughter and she literally knocked my door to see me so that she doesn't miss the cleaning appointment. Obviously, when I saw her teeth, she had worse teeth than normal people. But her death sentence was 10 years ago!!! It is the power of maintence in dentistry. You can not change your gene, but you can surely change the course of direction right away with your action.
A lot of patient tell me that deep cleaning doesn't sound like natural to them. I tell them it isn't! I am convinced that a lot of things in life is not natural. After few years of trying, I am so sure that violin playing is not natural. Only two generations ago, no one had deep cleaning and losing teeth in midlife was way of life. Now it is not acceptable and shouldn't be. But you have to do unnatural thing of maintaining in order to keep your teeth in your 70's and 80's.
First and foremost, integrity and honesty of the dentist should be the first requirements. You can never tell how technically superior dentist is. But you need to trust the dentist for long period of time. Big, complex, and difficult case often takes more than a year or even two years. When patients questions the intentions of my recommendations, sadly, I know that the patient is not ready to move forward to treat the work they deserve.
Secondly, the big case has to be planned carefully. Most of the patients think that the big, complex, and diffcult cases fail at the execution or technique stage, but reality is that it fails at the planning stage. As Benjamin Franklin said, "failure to plan is to plan to fail." Most of the true big cases are started and finished in less than 3 % of cases out of 100%. In other words, it is extremly rare to get treament done. I know, it is amazingly low number. But that is the reality.
Third, ask dentist what the final picture would look like at the end. It is perfectly okay to ask the question from you. Different dentist use different tool to visualize the end product for the patient, but in one way or the other, through simulation, mock up, or similar case photos, dentist can definitely show you what is going to be look. Dentist must have mental image of finished work. In comparison, often patients are clusless what it is going to be look like.
Big, complex, and difficult dental work is not something all dentist aspires to treat or deal with. It cause headache to even some dentist! Not all dentist should touch/enjoy the process. But, to me, the reward is much more satisfying than routine dental fillings. So, it is perfectly fine to ask another dentist or get second opinion than your previous dentist. By all means,it is not that your denist is not good. Good dentist is a dentist who knows and abide by the boundaries. I would rather choose a dentist who competent in small expertise than not so cometent in large expertise.
If someone told me at my dental school graudation that I would be the dentist who treat those big cases in New York, I would laugh so hard. But life is funny. . . Now, I have a burning passion to treat this small but rewarding segment of dental population.
Children need to brush "2 X 2". It means brush two times for two minutes. A lot of people think toothpaste as soap. The toothpaste company, Proctor and Gamble, love you to think that way. But that is not true. The toothpaste is more like medicine than soap. Because it is medicine, it has to linger in your mouth long enough to do the work. That is why two minutes is important. Average Americans, both adult and children brush 55 seconds, not even a full minute. You can get huge benefit by not rinsing with water after brushing. But most people don't like the taste of toothpaste to linger and most people don't need to go that far. Still in some case of people who don't brush while in braces can prevent the cavity.
For adults, it is get even harder, "3 x 3 x 3". The first three means that you have to brush three times a day. Yes three times a day. No compromise. If you stive for three times a day brushing, you will fall off to two once in a blue moon. That is much bettter than trying to brush two times a day. Again, key to success is not to make compromise.
The second three means that brushing for "three" minutes. When average American brush less than a minute, brushing three minutes can be seem ethernity. Once you try it, you will see how long the time is. The goal is for toothpaste to linger long enough to effect. So three minutes without compromise is the goal.
The last "three" is something that even my wife didn't get it. In fact, I have never met anyone who even guessed it right. Answer is that you have to brush within three minutes of your last meal. In other words, you have to brush right away rather than half an hour later. When you eat a meal, technically your mouth become acidic like car battery or soda. When you brush right away, the toothpaste neutralize and get rid of plaque right away before the plaque get stuck to the teeth and become hard stuff called tartar.
In summary, for kids, brush twice a day with two minutes.
for aduls, brush three times, for three minutes within three minutes of eating. Is that simple. Period.
I practice in lower Westchester, where the most people come in from all over the world for the "best". They want to live in the best, send their kids to the best, shop at the best mall, etc. Naturally, they want the best dentist. Not in a glitzy environment, but competant and caring so forth. So, for those people, they are already "fixed" their teeth and in good shape. A lot of people think that beautiful model or rich people goes to the cosmetic dental practices and fix their teeth all the time. The opposite is true. For those people, the job is already done long time ago. Therefore, mostly, my job is to "babysitting" their teeth, which is perfectly fine with me.
Second need for people, albeit small segment, is called big, complex, and difficult case, where many skills are needed to "resurrect the teeth" from the brink of extraction and dentures. In some sense, for them, I become a "dental hero". I don't think I would have gotten this much passion for dentistry without serving this segment of the population.
Still, the number of patient who need the big case and goes through all the treatment is extremly rare. Someone calculated approximate of 3% from who need the work. The reason is many folds. Trust, fear of pain, cost, findng the right denitst, not knowing what is available dentally. In order to follow through with the big, complex, and difficult case, the dentist must be able to utilize all the skill "at the fingertip" to make it work.
Often a dentist doesn't do certain procedure or develp disliking to perform certain procedure and favor one type of treatment to do. Still, if specialist is involved, it can be done very nicely. After all, that is why specialist exist in the first place. In dentistry, there are five practical specialists who can do just that. Endodontist for root canal, prosthodontist for bridges and crowns, orthodontists for braces, pedodontist for children, oral surgeon for extractions. For example, in Minnesota, there are seven prosthodontist, who are doing just that work. In comparison, in New York, we have so many prosthodontist that even one practice has two!.
But reality is that it just throws in another "monkey ranch" to the system rather than simplyfying the big picture. Imagine five busy dentist get together and decide what to do with one patient. The cost of spitting the fee among them often increase the burden toward the patient. The list goes on and on. No wander why no one does get through with the treatment!
Often, I am amazed how my patient is overconfident of their dental health. Most of them think that their teeth are younger than their physical age. I wish that is the true, but often the opposite is true. Often I see that their teeth are 10 years "older" than their physical health. Often, I see "extremly" healthy or rich patient has "extremly" poor gum and bone. If they realize what they have, I am sure that they will "run" to get it fixed.
Problem is not whether the treament option is available or not. Problem is that patient doesn't own the problem. They don't even know they have a problem! Gum and bone is as important as teeth itself. It is like having good brass section is as important as having good string section in orchestra. Sorry, I digress. . .
In medicine, blood pressure and blood work readily shows objective number that patient can understand. In dentistry, most patient doesn't know what they have. If it is "kind of ok", what is "kind of ok"? Compared to what? That is why the gum measurement is fundamental to dentistry and taught as dentistry 101. Sadly, the fundamental is not practiced as often as it should be done. As much as I practice in one of the most heavily saturated dentist area in the U.S., I see patient "never" got measured their gum health.
The problem with dentistry is that it rarely shows sign and symptoms to have some warning sign. Until too late. . . Warning sign would be of bad smell, bleeding, sensitivity etc. It comes much later when it is too late. When even you know that you have a gum problem, often it is too late. As Yogi Bera said, it is "getting late early". You've got to be healthy while you are healthy.
No. I am not an efficient dentist. Actually, I am so proud that I'm not an efficient dentist. I'd like to stay that way. . . How could life be all about being efficient? Lingering over lunch at the sidewalk cafe in Paris is horribly inefficient way to get nutrients. The most efficient way to get nutrition is to drink and eat handful of vitamins. That would be extremly efficient and boring. To me, life and dentistry is not about being efficient.
When I'm treating patient, I am not looking for the most efficient way to get the patient in and get the patient out the door. I would listen, talk and most importantly, not rushing anything. To this day, I never got stopped by the police for driving too slow on the road. I don't think I am slower than any other dentist! However, even in driving, I think, that there are too many people who wants to get from point A to point to B too fast, rushing.
What is the rush? If I can keep your teeth healthy, what's the rush to finish crown in an hour, finish braces in six months, finish implant toothth in a day? If I can keep my teeth forever, what's another month of waiting? That's why I don't like six month smile at all.
Braces is a beautiful thing. If I want to be healthy, having braces on is something to be proud of. I don't run in the morning with mustache disguise and sunglasses. Braces is not something to hide. Metal braces is a sign to the world that I am taking care of my body and will be even more healthier and beautiful. I love classical/traditional braces. It has lots of colors that you can choose.
I don't like "teeth in a day". I have been placing implants for 9 years including two year studying at the NYU. Still, I can't believe so many smart patient and dentist fall for "teeth in a day" or "teeth in an hour" concept. I have a story. Once, a world famous dentist was lecturing about different techniques on placing implant. Toward the end of the lecture, one dentist raised a hand and asked. "If you are placing implants on your family, which method would you choose? He said, without hesitation, " I would place using traditional method rather than teeth-in-an-hour-way." To me, he said it all that I needed to hear. Actually, I felt that I have wasted the whole day of seminar. If I wouldn't do it to my family, I wouldn't do it to my patient. Simple.
Effective dentist? Sure. . . Efficient dentist? . . . Efficient for whom? Would you be efficient to your family? No. Thank you.
1. Please treat our staff with dignity as we are trying to serve you the best we can.
2. Please call ASAP before cancelling the appointment.
3. Please done paying me when I am done treating you.
If you follow the ground rule, then I will die for you. . . I am just kidding. But every joke has a little bit of truth in it. I will do the best dentistry that I possibly know. I will bring Army. I will bring Navy. I will bring everyone. . . You've got the idea. I don't care how you got better as long as you get better. As a clinician, I know the boundaries of what works and what doesn't work in real life.
That might even include no treatment. Sometimes, no treatment is the best treatment. That's why medicine's first rule is "do no harm". I have a story. There is one famous soccer player named Jisung Park. He wouldn't be a star player today if his surgeon had operated on his ankle when he was young. As NewYork-Presbyterian hospital motto says, we have the best technology so that we don't have to use on you. But, once I start treating you, you can be assured that I will be using the best lab, material, and minimal invasive technique on you. I am so proud that half of my patient didn't even take a mortrin after implant surgery.
We book by appointment only. We don't double book our patients. When an office double book, it means that the office assumes that you won't show up. We assume that you will show up. That means no waiting for you and the next person. If we ever late for more than 10-15 minutes late, you might be surprised with little gift card handing it to you. It is not normal nor okay in our office because you are not a number in our office. Staff might even ask you if you are okay because no one cancel in our office unless they are sick.
Our hygienist, Ruby found an interesing article on web. Enjoy!
Seeing great dentists motivate me. Just like any field, in dentistry, there are some good ones, some bad ones, and some great ones. I'd like to learn from the best and try to copy what they have been successful for years of practicing dentistry. . . Peter Dawson, John Kois, L.D. Pankey, Cathy Jameson, Linda Miles, etc. If I've ever been good, that's because I try to stand on the shoulder of those dental giants. As Dr. Dick Barnes said, I am trying to be a better dentist every year.
Similarly, as a young associate dentist, that's what I absorbed like sponge when I work with Dr. Anthony A. for a year and half. One day, when he put me aside and said, "I have seen your work and mostly you. . . You are a good guy. . . I am tired now, but I have made it. As you can see, we have wonderful patients come here, some rich, some poor, some smart, some working family. Just right mix. Just do as I have done in here, and you will be successful. . . Buy this practice from me. . . Who in the right mind would say no to that propostion? When a King hands you the key to the kingdom, how would anyone not take it? I said, "Yes. I will. Thanks Dr. A." That was seven years ago.
Just like a son tries to make his own mistake/life, I have tried and learned some more along the way. Even though I really miss the days that I worked along with him, I would do the same thing of being independent if I ever do it all over again.