Quick! Dental peeps, are you overdue for a preventive hygiene visit (aka…a cleaning?)

If you’re like most dentists I know, you probably are. So what does that say about us? What about a dentist with really nasty looking teeth? If you aren’t taking care of your teeth at least as well as your patients you’re kind of a hypocrite, right?

You would think that dental people have lower risk factors for dental problems. We’re supposed to know how to brush and floss and I’m sure our patients assume that we’re olympians in dental hygiene. (As an aside, did you know that I won gold in tongue scraping back in 1996? True story.)

The question I would ask of dentists and dental people in general…do you walk the walk? Do you have have a dentist that treats you? Do you go for regular visits? Would you do the treatment that you recommend for your patients?

One other thing. If you don’t have a dentist because you don’t think you’d trust your dental care to anyone but your awesome self it doesn’t make you superior. It makes you a douchebag. Get a dentist and show up. At the very least we ought to remember what it feels like to lean back in a dental chair at least a couple times a year.

By the way, I’m due for hygiene on 7/24/2012 and I was inspired to write this post because I think I broke a tooth.



Less Tylenol

They’re changing Vicodin. According to the FDA, it’s got too much Tylenol (acetaminophen) in it. So they’re going to “fix” it.

Combination drugs containing hydrocodone and acetaminophen like Vicodin, Lorcet, Norco and similar generics are incredibly popular for treating pain. They’re typically used in treating acute post surgical pain, ideally for short term use. Since 2007 the use of these drugs in patients 60 years and older has increased 32%. In other words, these medications are being used for chronic pain conditions more now than ever before. Some are lobbying the FDA to outlaw the use of these drugs to treat chronic pain, presumably because of their “habit forming” qualities as well as the toxicity of high doses of acetaminophen.

The FDA is requiring that these combination drugs be reformulated using less acetaminophen by January of 2014. The most common formulations right now are Vicodin 5/500 (acetaminophen/hydrocodone), Vicodin ES (7.5/750), Lorcet 10/650, or Vicodin HP (10/750) The maximum “safe” dose of acetaminophen is 4 grams or 4000 milligrams per day, with no more than 1 gram (1000 milligrams) in a dose. Some have questioned if even these safe levels are too high due to the effect of acetaminophen on the liver. In high doses, acetaminophen is toxic to the liver. Every label of every product that contains acetaminophen is required to explain this in detail. The problem is, most folks don’t read the label.

It’s likely that this “overdosing” of acetaminophen is of two types. The first type is from ignorance. Many cold remedies and over the counter pain formulations contain acetaminophen and consumers don’t realize it. If someone has the flu, they may take a flu remedy with acetaminophen as well as a Tylenol to bring down a fever. This can inadvertently cause an acetaminophen overdose.

The second type of acetaminophen overdose comes from those who are abusing the drug. Hydrocodone is an opiate drug like codeine, morphine and heroin. It can cause intense euphoria and is used by many to get high. Someone who uses opiate medications often, whether for pain or for recreation, will become tolerant to the medication. Tolerance is the tendency to need more of a drug to get a similar effect from the drug. This is very common in abused drugs, but also happens with many  “non-abusable” drugs.

People who use combination drugs to get high are at high risk for serious liver damage. Once you’ve gained a tolerance for the medication, you’re going to use more or you’ll go into withdrawal. Some make the argument that keeping the acetaminophen amounts high in these medications will discourage addicts from taking too much. Personal experience tells me that someone who has become dependent on an opiate medication is usually not making decisions based on liver toxicity. They’re trying to avoid being sick from withdrawal.

We know now that we need to be more aware of potential acetaminophen overdoses. So what’s the solution? I have a couple thoughts:

  • read labels: If we could count on people to read the label we wouldn’t see so much accidental liver toxicity. So patients need to be told explicitly that the medication they’re receiving had acetaminophen in it by you and your staff. Along with explaining it verbally, it probably need to be explained in writing. Post op instructions that can be reviewed after the fact or on a website would be a great place to explain this again. It’s probably worth making sure the patient knows that they need to read every label of over the counter medications to be sure of what they’re taking. (duh)
  • do the math: If you’re doing a procedure where you think it’s appropriate to prescribe a combination drug like Vicodin, make sure you do the math for the patient. Explain that the patient should not take any more than x tablets of a medication per dose and no more than x doses per day.
  • smaller doses: With the new FDA changes, combination drugs will have no more than 300mg per tablet. But in the mean time, I would prescribe Lorcet 10/650 with instructions to take half a tablet. The tablets are scored to be broken in half so it’s more like prescribing a 5/325 dose.
  • avoid acetaminophen: Let’s face it…dental pain is almost always inflammatory in nature. Acetaminophen isn’t an antiinflammatory. We’ve got better options. Even if you want to prescribe an opiate. Vicoprofen is generic now, so you can prescribe a 7.5mg hydrocodone/200mg ibuprofen dose on a generic cost basis. Even better is a newer medication (not generic yet) called Reprexain. It allows you to prescribe 200mg of ibuprofen with with either 2.5, 5 or 10mg of hydrocodone. I have to thank my friend Matt Ray for this info as I hadn’t heard of it before. This gives a doc a lot of options in prescribing for pain. Since I usually recommend taking acetaminophen along with ibuprofen this new medication gives a lot of flexibility.
In a perfect world our patients would be completely aware of what’s in every medication that they take and they would never mistakenly (or intentionally) take too much Tylenol. The same perfect world would be inhabited by awesome flossers that don’t drink alcohol and aren’t overweight. Since we don’t live in a perfect world it falls to us as doctors, to educate and help them manage pain and avoid medication toxicity.
Did you like this post? Do you have questions or comments? Please leave a comment in the form below. I really enjoy the comments section and I’ll make sure to reply to any !


my most valuable url

I got this in my email last Saturday:


B***** M****j
Email: *********dy@me.com
Phone: (989)***-6***
Preferred Method of Contact: Email
Preferred Appointment Time: Morning

I am looking for a new dentist and would like to make an appointment if you are accepting new patients.  Thank you!


and this one today:


Kevin ***d
Email: t******@yahoo.com
Preferred Method of Contact: Email
Preferred Appointment Time: No Preference

I have severe tooth pain. I think I have cavities.


Both of these leads came directly to my email and my office manager’s email  from my “make an appointment online” link. You can see that link here: http://meadfamilydental.com/appointment.

My office website/blog does pretty well on Google. At least it has up to this point. With all the new changes to Google Places I’m not sure, but my expectation is that we’ll come out in pretty good shape. Maybe even better than before. We’ve got a lot of good Google reviews, so when my site shows up in the top 3 or 4 on Google’s first page, people often check out the site. This is where having great blog content comes in!

They see my site and maybe they browse around. They get the feel for the office from my regular postings and you’ll find that I link to my “make an appointment online” page in almost every one of my blog posts. I learned from my friend Mike Barr that your website needs to not only have engaging content but a “call to action.” If they like what they see, you have to make it easy for them to take the next step. Thus, the “make an appointment online” link.

Getting them to email you is only the first part. Many websites have one of these links. I make it my business to email the patient back as soon as possible. You know why? Because most websites that you ask for more information about never do anything with the request. I can’t tell you the number of times I’ve taken the time to fill out a “request for more information” form online and never gotten any response at all.

My goal is to have that prospective patient say to themselves or anyone else around them, “I’ve never been treated so well before!” Or, “wow, the dentist took the time to email me back!” They’re going to have a different kind of experience at my office, and I want them to know that from the very beginning. Here’s what I wrote to one of my most recent requests:


Hi *******! We’d love to have you! Are you having any troubles with your teeth, or are you looking to have a cleaning first? We’ll get back to you first thing on Monday morning to get you set up. Thanks for emailing!

Alan Mead DDS


The prospective patient replied:


Thank you for the quick reply! I don’t really have any problems with my teeth that I know of, I’m just a little overdue for a cleaning. I am also interested in your Gold Plan, as I do not currently have dental insurance. Thank you


I think I answered her email on my phone, but I can’t remember. All I know is it took about 2 minutes. I saw her as a new patient this morning. She joined our “Gold Club.” It doesn’t always work out that smoothly, but usually it’s just like that. If I don’t get to it immediately, my office manager does. We just write a friendly, personal email or make a quick call to welcome them. So simple, so effective.

Do you have an appointment form online? If you do, do you answer it immediately and with a kind, personal welcome message? If you don’t have something like it, I highly recommend it! It’s been working really well for us!

40 minutes. One way.

I have a commute to work. I live west of Midland, Michigan and my office is in Saginaw Township, Michigan. I’ve been driving roughly the same route for 14+ years. 80 minutes per day. 4 times per week. When you do the math, it’s kind of depressing. I’ve been commuting close to 150 days straight.

I often hear about colleagues who have a two minute drive to the office. “Yeah, it’s two or three minutes. It just depends on whether I catch the light.” Or better yet, “It only takes me five minutes to walk to the office, so I usually go home for lunch.”

Then there’s the guy in New York City who lives upstairs from the office. That’s way too close, in my opinion. Or at least don’t let your patients know it. I’d feel a lot more comfortable calling on a Saturday if I knew it was only a walk down the stairs for you. Just sayin’.

There are obvious advantages to a short commute. I think of all the wasted time that I could be spending with my family. I have two little boys, so they’re not in a lot of activities yet, but I know that’s going to be complicated. I’m not sure how it’s going to work. Perhaps I’ll squish a four day week into three days some of the time. I’ll cross that bridge when I get to it. A shorter commute would allow me to sleep in a little longer, too. I feed 12 horses, two dogs and a miniature donkey most mornings. So I get up pretty early. Shaving a half hour off of my commute would mean another half hour of shut-eye. I’ve always been one to go to bed early, but that gives me even more of an excuse.

I generally like to know what’s on the schedule for tomorrow and even for the week. So I usually go online to check the schedule if I didn’t take a look the day before. Occasionally you’ll see that one patient on the schedule. You know the one. She’s the one that makes you contemplate injuring yourself while mowing the lawn, just so you can miss tomorrow. Or the guy with the removable case that gets worse. Every. Time. You. Touch. It.

I’m here to tell you. 40 minutes is a long time to think about those patients. 40 minutes gives me time to contemplate each and every way that appointment can go horribly wrong. By the time I get to work, I’ve already lived those tragedies in my mind several times. The upside is that they never go as badly as I’ve imagined them. There’s almost always less swearing and often less bleeding.

The upside of a 40 minute commute is that there’s some time to unwind from work. I listen to audiobooks and podcasts almost constantly. 80 minutes a day gives me some time to enjoy these. I also use the Spotify premium app to listen to whatever kind of music I’m feeling like. My time in the car allows me a chance to think of ideas to blog about. Some of my best ideas for www.meadfamilydental.com have come in my morning commute. This very blog post was inspired by the ride in this morning. I’m less creative in the afternoon, since I’ve usually spent the day working on patients so I generally just unwind. But I think my family gets a better, more relaxed version of me because I’ve got decompression time.

Anyone else have a commute? I’m interested to hear about it. Thanks for reading!

Why dental presentations and dental presenters usually suck

Public speaking is my bag. No, seriously. I like speaking about topics I’m passionate about in front of a group. And I’ve been told that I’m pretty good at it. I keep getting asked back, so I must not be too bad.

I would like it even more if it were really easy to put together a good presentation. It’s not at all. And worse than that, I’m a terrible procrastinator. If I could just fast forward past the idea generation, slide design and rehearsal I’d be in heaven. The actual getting in front of a group and doing it is a blast. There have only been a couple times when I didn’t do well in front of a group. Very occasionally I just don’t connect with an audience or they just aren’t into the subject matter. Sometimes I don’t think I’m connecting and I’m doing O.K. But usually you can tell by the energy of the audience.

One reason why presenting to dental audiences is hard is the amount of time we’re supposed to present. The classic dental meeting time frames are 3 hours (“half day”) or 6 hours (“full day”). John Medina, author of “Brain Rules” suggests that 50 minutes is the maximum amount of time an audience can stay involved with a presentation. Further, the presenter has to do something different to grab their attention every 10 minutes or they’re toast. My experience tends to agree with this.

So why do we have 3 hour and 6 hour classes? I don’t know. The courses I took at the Chicago Midwinter this year were varied. One was really bad, a couple were pretty good. All were 3 hours. And every last one of them should have been no longer than an hour and a half. That would have required the speakers to boil it down and would not have required the audience to have such endurance.

The other problem is the speakers. As speakers, we need to remember that we’re there for the audience, not vice versa. In other words, it’s not about the speaker. It’s about the audience. It’s not lecturing, or at least it shouldn’t be. It’s closer to a performance or, as Garr Reynolds describes, a conversation.

A couple pet peeves of mine when I’m watching a speaker:

  • The speaker reads their slides…usually bullet point by bullet point. No offense, but you could have emailed me that and saved me the trip.
  • The speaker prepared the slides up to the morning of the presentation and never did any rehearsal. I’ve been guilty of this in the past. I’m trying to get better. Just try not to be baffled by your own slide deck, mmmkay?
  • The speaker isn’t sure how long their stuff is going to take. So, they go way over. Usually into lunch. Don’t do this. Ever. Go short as much as you want. Don’t go long. It’s rude and disrespectful of your audience. Remember, going “short” means there’s plenty of time for questions.

Dentists and dental teams are above average audiences. They forgive a lot. Trust me, I know. They can stay with you on the wildest tangent and they’ll overlook your awful tie if you treat them with respect. They’re colleagues and they want you to do well. Just do your part as a speaker and they’ll keep asking you back. Or at least that’s my experience.