So here I am, back at work on a Monday morning (well, now a Monday afternoon) after a weekend of classes and socializing, and being accosted by salesman types.

More enthusiasm? In my last post I mentioned that I could use a dose of enthusiasm for work, and I got at least a little. I went to 12 hours of lectures, 6 on Friday and 6 on Saturday. 9 hours were devoted to esthetic dentistry - so-called "wants-based" dentistry. The other three were a series of one-hour lectures on varying subjects. The first was on pharmacologic management of difficult patients. Sounds more interesting than it was, since I don't generally do any sedation for my patients beyond a little nitrous oxide (laughing gas). I don't give them drugs before the appointment, I don't put them to sleep, and I generally refer anyone I cannot handle in a normal manner.

The second was on self-adhesive cements. This was just an overview on a relatively new type of cement we have at our disposal. I use one and this was actually useful AND entertaining, as the speaker (who was from Venezuela) was sort of a joker.

The third was on TMJ (temporomandibular joint) appliance therapy. This was probably the one I was most interested in going into the afternoon, but it ended up being the least useful of the three, mostly because I don't agree with most of his treatment protocols. They may work in his hands, though I don't understand why because they would seem to go against all the principles I've learned to make the muscles, teeth and joints work in harmony...

The other nine hours were spent on two speakers who discussed improving patients' smiles, with porcelain veneers. Anyone who has seen one of those "Extreme Makeover" TV shows knows about this sort of dentistry - this is for the patient who comes in with badly aligned, poorly colored, or otherwise less than perfect smiles and front teeth.

When I type it, it seems like such an unworthy pursuit, but there are a lot of patients who want it. I had a twenty something young man in here about a month ago, his front teeth looked terrible, and he wanted something done because he had a wedding this month. I did a couple of all ceramic crowns and some bonding. Did he need it? Well, he though he did - he didn't hardly smile. But you should have seen him smiling when I put in the crowns and bonded his teeth to match.

I really enjoy doing stuff like this. I see a lot of teeth that "need" specific work - say, a root canal, a crown, a big filling - and people don't really have much appreciation for that work, because they don't "know" they need it. It doesn't hurt. It doesn't really bug them. And some people just don't quite believe that they require that crown, that root canal, even something simple like a filling. If it doesn't hurt them, they don't really believe it. Cavities don't hurt until they're so big they are affecting the nerve, but I can't tell you how many times (today!) I've heard "Do I really need that filling you're recommending? Because the tooth has never hurt."

But a cosmetic case, where you make a dramatic improvement in someone's smile, they want it. They appreciate the level of quality I'm able to provide. I don't think I'm the best dentist in the world (if I was, I'd probably have been lecturing at the Chicago Midwinter Meeting rather than listening to lectures), but I'm pretty darned good at what I do. And when I finish any work, I take pride in it, and I do the best job I can. And that's pretty darned good, in my opinion.

That's what I'm trying to say about it being more rewarding to do a cosmetic case. You make a NOTICEABLE improvement, and the patient appreciates it and is really grateful for the work.

So why do I sit in on cosmetic lectures? Well, the obvious reason is SO I CAN GET BETTER AT DOING THEM. And when I do a nice cosmetic case, the patient and EVERYONE WHO SEES THEM knows exactly how good I am. It's out there for the world to see. (I've seen "cosmetic work" on patients that I wouldn't want anyone to ever see had I been the dentist who did that work.) And that means more referrals. More patients. Busier. You can draw the rest of that line yourself.

And it's still "back to work".