My job

John,

You asked about what it is that I do.  Well, four days a week I am in private practice here in Mesa, AZ.   I am a family dentist and cater to all ages 2 to 102 years.  I do about 85% of the work that walks though my door and refer out the other 15% when prudent.  Ultimately I ask myself, "Would I do this to me?"  If the answer is yes then I do it, if not then I refer out.  I am blessed to have some very talented people in my area to refer to when the case is beyond my abilities.  Some types of cases I may see examples of only once a year, but the specialists may see every week.  So who do you think is going to be better prepared for those cases?  Having said that, I still see quite a few interesting things.

Now, I'm not even going to try to compare what I do to what you do.  There is no comparison.  However, I still think much of what I do is cool.  One of the best things is the use of lasers in my office.  Right now I have two different types.  One is a diode laser, but the hygienist uses that one more regularly than I do.  The one I use is referred to as an Erbium Chromium:YSGG hard and soft tissue laser:

It is self contained and can move from room to room.  I have an air source set up in each room, but the water source is onboard so it is easy enough to move around.  You just have to reboot the computer each time you move it to another room.

It was quite the investment for me.  When it was all said and done, the unit and the advanced training I paid for cost more than my first house.  But I am glad I did it.

Originally I was not wanting to invest without knowing more, so I flew to North Carolina for a two-day training course.  I sat there with 29 other dentists who already had owned the machine for more than a year.  As they went around the room and told how long they had their units, but were not using them because they didn't know how, I was amazed that anyone would do such a thing.  When they got to me I told them where I was from, but that I did not own a Biolase yet.  One guy looked at me in disgust and asked why I was here if I didn't even have a unit in my office.  I looked him in the eye and said, "Because I don't want to be like you; paying for something you don't even know how to use."  No one gave me any problems the rest of the weekend.  I went on to buy a unit a week later and started using it the day after it was installed.  I went on to take quite a bit of advanced training and even have my fellowship in the World Clinical Laser Institute.  Part of the reason I teach at the dental school is to be able to lend my knowledge about lasers to the students.

One of the coolest things about the laser is the ability to do dentistry with limited or no anesthesia.  I used the laser to do a filling on my daughter a year or two ago.  I was explaining the process to someone once and my daughter butted in to say she didn't have any fillings.  I told her that yes, she had a filling and I went on to explain it to her.  She thought I was just cleaning her teeth.  She had no idea I cut a large hole in her tooth and then filled it.  I did this with no anesthesia or needles at all.  Let me show you a few examples of things I have actually done with either no anesthesia at all or only a topical gel:

Now keep in mind, these teeth have had no anesthesia.  Some times I use a topical gel with lidocaine and tetracaine in it, but it is placed on the gingiva only.  No hypodermic needles are used at all.  Squirt it on, let it sit for two minutes, rinse it off and get started.  The laser has an amazing effect on the nerve of the tooth to deaden the response or remove the nerve response completely.  It works even better on baby teeth.

Anyway, this is a pretty straight-forward case.  A couple of one-surface cavities.  A rubber dam was used to isolate the teeth for preparation and also make it easier to get the pictures.

You can see the actual preparations I made in each tooth with the laser... again, with no anesthesia.  Each patient is different of course.  Some don't feel a thing and others are a bit squirmish.  Most feel a sensation of "cold," but say they would much rather feel the cold sensation for a few minutes rather than the "numb" sensation for 4-6 hours with the use of an anesthetic.

The laser works perfectly for people who have virgin decay like this example or for "white" fillings made out of composite materials.  However, silver fillings really need to be removed with a traditional drill and that requires anesthetic.

This is another great example of how the laser works.  It may be hard for you to fully appreciate, but this picture was taken after I had already done a gingivectomy to the gum tissues around the obvious cavities in these teeth.  The gums partially covered the lesions in question, so I re-contoured the gingiva to be able to expose the carious lesions.  Note the lack of blood!  That does not happen when you use a scalpel to do the same thing.

In this case a topical was used so that I could get through the case quicker.  Once the soft tissues were taken care of I switched settings to remove the carious lesions in the hard tissues.

After that I was able to restore the teeth with composite fillings that mimic the natural color of the teeth.  This picture was taken moments after I was finished.  Again, no bleeding and no needles.  This patient was able to go directly to lunch with his wife without worrying about how he sounded or biting himself.  I think it's cool.

This is my oldest son just prior to getting braces on.  That flap of tissue between the teeth is called a frenum.  This attachment is too close to the teeth and can cause problems down the road as the teeth are moved around, so we decided to alter the attachment by simply removing it.

I should have put in the inter-operative and healing photos, but this is still pretty amazing.  The second picture is 14 days post-op.

At the time of the surgery I made a hole about the size of a quarter and did it with no bleeding.  And again, it was done with no needles and no pain.  In and out in five minutes.  Then we went out for burgers afterward as if nothing had been done.

This last picture of laser surgery is of an erupting tooth that needs to have an orthodontic band placed around it.  That flap of skin is called an operculum and it is obviously in the way.  The orthodontist needed it removed so that he can get the band around the tooth.

While it can be done without topical anesthesia, I find that a little topical makes things move a lot quicker.  So after two minutes of topical I quickly plowed into this operculum and removed it with no bleeding and no post-operative pain.  I forgot to mention, the laser cauterizes the vascular, nervous, and lymphatic tissues so there is no bleeding, pain, or swelling after I use the laser for these soft-tissue surgeries.

I love this stuff!

This patient went directly from my office to the ortho office to have the band placed and then right back to school for a math test.

Well, lasers can't take care of all their problems.


So, that is fun with lasers.  But I do a lot more than that.  I do quite a bit of everything.  Let's take a quick look at a few other things I do in my little office:

Oral surgery:  I love exodontia!  This is a pretty normal situation  for me in my office.  This is something that takes local anesthesia.  No topical here.  Some patients prefer not to be sedated, so I will do them in my office.  I decided a long time ago not to do sedation in my office.  That is what oral surgeons are for.  But this case was done in my office.

The laser works well in this situation as well as a drill.  I can make the initial incision with the laser, basically fillet the soft tissue from the bone with the laser, and then switch over to a hard-tissue setting to reduce the bone to get the tooth out.  All of this can be done with traditional techniques, but that requires a lot more muscle.  And you know my little chicken arms don't like that kind of work.

This case was finished with a bone graft as seen in the lower radiograph.

Cosmetics are a big thing these days.  I don't consider myself a cosmetic dentist, but people don't like the look of old silver fillings.

As they break down and wear out they have to be replaced.  I like to make things look as natural as possible.  This is a rather normal situation seen on a daily basis in my office.  And I do have to use lidocaine and the drill to make the top photo look like the bottom one.

Implants are a fascinating treatment option for patients to replace a single tooth or an entire arch.  This patient decided to do a screw-retained overdenture which allows her to keep it in 24 hours a day without removal, but allows me to get it out when I want to check or clean around the implants she has.  These are big cases done in concert with an oral surgeon.  People who have worn dentures for years break down and cry when we give them back something they have lost for many years.


Cosmetic cases mean a lot of things to a lot of people. Some think it is done out of vanity.  Some think it is a way to take them from a good situation to a better one.  Some think it is a ridiculous use of resources and others consider it a life-altering experience.  Take this case here:

This is a 40+ year-old woman who had been embarrassed of her smile her entire life.  She was an actress in local stage productions and felt she was placed in lesser roles because of her less-than-perfect smile.  As she explained her life story she broke down in tears.  She did not have the finances to do a full-mouth reconstruction.  Her story and emotions were honest.  So I decided to do the case for the cost of the lab fees alone:

I would love to show you the before and after head shots, but can't due to HIPAA laws, as you very well understand.  Let me just say that simply fixing the smile fixes a lot of other things at the same time.  This individual smiles all the time now.  She stands more erect and she is convinced that her acting career has been greatly advanced simply because her smile "wows people!"  Her words, not mine.  She now works for Disney Co.  and travels the world playing different live characters, one being Mrs. Claus to Santa in Tokyo Japan this past Christmas for Disneyland.  She is very happy.

Another patient with a similar situation related a story to me after her treatment was completed.  Her mother was soon to pass away in a hospice setting.  The mother was very ill and little could be done to comfort her.  My patient, relating the story to me, said that when she got to her mother's bedside she sat and talked to her for a number of hours.  She realized that her ailing mother was calmed and pleasantly content.  She asked the mother how she was feeling.  Her mother took her by the hand and said, "It is good to see you smile again.  I have not seen you happy in so many years.  It makes me happy to see you this way."  The mother died the next day.  My patient, though her tears, thanked me for that last, precious memory between her and her mother.

Every job has its ups and down, pros and cons, good and bad.  I could spend hours slogging though the grief that my profession causes me, but I would be ungrateful if I did.  I know you know what I'm talking about.

With that in mind, good night.