Mr. Kirch celebrated his 100th birthday today. We had music. We had cake.
These things don't happen every day, you know. I fact, only about 0.02% of human beings ever live to reach and surpass 100 years of age.
Mr. Kirch was an attorney who worked in the realm of commercial law, and was house counsel for the Gimbels department store as well. He is a lifelong classical music lover and we have enjoyed countless conversations about everything from Josquin to Webern, from symphonies to chamber music. In fact, I once tickled his fancy with that classic classical musician's pun, "We perform Strauss frequently, but, I regret to say, we don't Offenbach."
On the left providing a little live music for the occasion is Jon Dichter-- friend, patient, splendid musician and, on top of all that, expert in the arcane art of piano tuning and repair. How nice it was to have live music waft throughout our office for a little while on a Thursday afternoon.
Young folks always end up asking those who reach an advanced age relatively intact what they view is the key to a long and healthy life. Mr. Kirch answered this question with estimable common sense: "I exercise, keep my mind active and I think I eat pretty well."
He asked to take home "just one small piece of cake."
So, a hearty mazel tov on becoming a centenarian, Mr. Kirch. Though I gazed upon the body of a one-hundred-year-old man, I truly saw the glimmer of the little boy who endured inside; the little boy who was once again delighted by cake, candles, the warmth of dedicated friends and a little music on his birthday.
Selfish businesses have to advertise (read: interrupt) a lot harder than generous ones.
Generous businesses are a lot more interesting than selfish businesses.
Many people believe that generosity is a zero-sum game. One person gives, another receives. I give you this, you take that, and the whole thing zeroes out.
But what if the truth is that generosity makes the whole Pie grow bigger?
I mainly wrote this because I come in contact with young dentists who are treated poorly by their employer. Corporate dentistry, yes, but also group and small practices.
I don't understand it, except to surmise that these owners are engaged in scarcity-thinking. You know--there's only so much "Pie," so they greedily grab their piece and leave the crumbs to associates and employees.
It's not only wrong (we're all colleagues with the same degree and rights/responsibilities in front of the law), but ultimately foolish to behave in this way.
The opposite of scarcity-thinking is, naturally, abundance-thinking. Established doctors who think in terms of abundance will strive to launch a new associate into a splendid and meaningful career. Abundance-thinking also applies to staff. Pay them well, train them well, empower them to make decisions and expand their abilities. It may cost a little more than hiring cheap disposable drones, but turnover is even more expensive, and today's patients notice this kind of thing.
Mostly, I'm tired of hearing of young colleagues being treated poorly and every chance I get I plant the seeds of a better paradigm.
I'm also thinking of patients when I say generosity. Like...
-We have a fun, engaging referral program that gives patients a credit for referring someone new.
-We create online content that teaches prevention and educates patients, and we don't try to monetize it.
-We frequently have pre-dental shadows visit. Seeing what it does for them, and having all kinds of interesting patients with diverse careers, we'll connect a young patient with someone in the field they're interested in. Word spreads...
-Once, knowing a patient came to our office by bike, I saw her for an issue on a day that was inconvenient for me, rather than on the next day when I had time--but when rain was called for.
-I recently asked a nun, who teaches, how things were going in her school. She's normally full of jokes and laughter, but this time she was downcast. Told me a young girl with no father had just lost her mother at a young age. I said, "How do you think she'd feel about no-fee dentistry until further notice?" Nun cried. We met the remarkable girl, who made a big impact on me with her strength and potential. (The way I see it: Transactions can be vitally important. Absolutely. But only gifts of the heart can make you cry, or give a story you'll tell for the rest of your life.)
I have so many amazing colleagues who do this sort of thing all the time. Thousands of variations. We really should write a book or share on a website or something. The thing is, when American dentistry was shunned by the founders of the American Medical Association in the 1840s, it may have seemed insulting at the time, but those buttoned-down Victorian docs did us a massive favor that's still contributing to our freedom 170 years on. We escaped becoming part of The System. We have autonomy (if we want it). We're largely free from bureaucratic stifling of creativity.
Scaling and Root Planing is the process of removing dental plaque, tartar (calculus) and toxins from the teeth and thus re-establishing health in gums which were diseased by these noxious agents.
And it really needs a better name.
I have a relative from a faraway city who was once faced with the need for this procedure. She could afford it. She wasn't afraid of it. She could set aside the time for the two visits required. All the usual objections to treatment did not apply for her. And yet she simply couldn't bring herself to make the appointments. Why?
Because "I refuse to do something called 'scaling and root planing.' Call it something else, and I'll do it."
And so her good-listener dentist re-named the procedure "Root Enhancements" and, happy in her self-aware self-deception, she set her jib and sailed through the procedure without ever looking back.
What is this procedure, and why would someone need it?
Our bodies are being assaulted by germs all the time. Many are beneficial. Just try eating stuff like Cockles and Whelks, Dim Sum with Chicken Feet, Mongolian Boiled Whole Sheep's Head with Root Vegetables or the deceptively named Sweetbreads-- try that without all those beneficial vitamin K-producing bacteria in your gut and see how you get along.
Of course, not all bacteria are friendlies. Our immune system is always our main defense against those many mean-spirited bacteria and viruses that mean us harm. Yet our bodies also have other defenses, and a vital one is the barrier that skin and covering surfaces present to germs of all types. If they can't get in, they can't win.
Our skin and the mucous membranes that count as skin inside the mouth are constantly shedding off surface cells and renewing themselves from underneath. Renewal and turnover is a key defense against germs. They just float away with the dead skin. And yet consider teeth for a moment. They're different! They grow inside our jawbones and then come into the harsh environment of the mouth when we're kids, never to regenerate or heal themselves again. Any bit of a tooth that breaks or decays or wears away is gone forever. Further, there's no shedding-and-renewal process going on in the outer layers of teeth.
So while all those germs on our cheeks and tongue eventually get washed away down the Alimentary Canal, the ones that manage to stick to our teeth find themselves comfortable and happy, and before we know it they've built their own little germy version of Levittown, New York...
Here's a healthy tooth, with no plaque or calculus at all. An idealized situation that lasts mere minutes after your hygienist or dentist has just finished your professional cleaning--
The tan is bone, and the pink is of course gums. There's always a little separation between gums and tooth, as evidenced by the periodontal probe (something else that desperately needs a rebooted name) angling in to measure. We consider 1 to 3 millimeters to be in the healthy range of these gum measurements.
Now watch as a hypothetical patient doesn't visit a real, or hypothetical, dentist for some years. We'll see the biofilm, consisting of soft plaque and hard calculus, build and build and build, damaging the gums and bone along the way--
The dental plaque, calculus and toxins are highly irritating to the band of gums around our teeth. The longer they sit there, the deeper the pockets under the gums, the more dangerous the types of germs that move into their expanding Oral Levittown, and the more inflammation results. It's a vicious cycle that leads to the jawbone melting away and, eventually, loss of teeth. This is full-fledged gum disease, called periodontal disease by the dental profession.
It's also relatively painless until near the end. Thus, periodontal disease joins the ranks of high blood pressure, glaucoma and hundreds of other dangerous medical conditions that don't give us early warning by hurting us.
If we diagnose periodontal disease early enough, while the jawbone is still mostly where it needs to be, we can meticulously clean away the dental plaque and calculus and the body will heal. Our patient may have lost a little supporting bone, but if health is regained (and maintained going forward!) they will still have full function and a beautiful smile.
And we do this by Root Enhancements, which in a bygone, more barbaric age used to be called Scaling and Root Planing. We anesthetize for patient comfort and we use very-analog hand instruments and ultrasonic scalers--ah, "enhancers"--which kill the germs and stream them away. It all goes like this:
This would be the situation minutes after the procedure. Still inflamed, but no more plaque and calculus. If our patient brushes and cleans between their teeth each day, in a week or two they'll be back to this healthy situation:
When periodontal disease is very severe, Root Enhancements alone are not enough to restore health, since the damage to the bone and gums leaves the bad germs all kinds of places to hide and build anew. There are regenerative surgical techniques for this condition that we will explore another time. For now, the best advice is: see your dentist every six months. It's better to kill the monster when it's small, and intercepting early, localized gum disease is a lot easier than trying to fight it when it's melted away a lot of bone.
That's kind of like trying to return Levittown, New York to primeval forest...