Practice Mojo

My good friend and mentor Jim Rhode told me, "you need to look at this Practice Mojo (PM) program for your office."  He couldn't have been more right.  Practice Mojo automates our appointment confirmations, reminds our patients about their need for followup appointments and tells them when they are past due for ther cleanings.  It also allows patients we have seen to complete a survey about their experience in our office.

PM also tells our office about how well we are managing our recare schedule and gives us demographic information about our patients.  It allows us to send specialized messages to our patients through email, text messages, or customized message postcards.

Our experience with this program since inception has been excellent.  The first thing we noticed was the appreciation from our patients about enhanced communication.  Almost daily, we have a patient call us and tell us that they are surprised and impressed that we have sent them a text message to remind them of their appointment.  They actually take the time to call and tell us they are impressed!

Another patient called to let us know that the postcard we sent was "a cut above the other junk you get in the mail."

The surveys we have received to date have been 100%.  Now I know that it's not possible to have that track record continually, but it has been a great team encouragement to date.  The comments patients add to their surveys have been glowing.  Remarkably, the dental TEAM has been mentioned in nearly all of the comments.

Thanks Jim Rhode for a great recommendation.  Our patients and all of us here at the Jacobs Smile Center are encouraged by this new technology!

Invest In Your Dentist - Perioeconomics

According to a Pew Center report, more Americans are turning to the emergency room for routine dental problems — a choice that often costs 10 times more than preventive care and offers far fewer treatment options than a dentist's office. Many of those emergency visits involve trouble such as toothaches. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips, the analysis said.That's because emergency rooms generally are not staffed by dentists.

Simply seeing your dentist for routine checkups and preventive care could save millions of dollars to society.

Perioeconomics is about the financial impact of oral disease on society and medical care costs.

81 BILLION dollars was spent in the U.S. in 2006 as a result of oral biofilm (Flemmig et al 2011). Spread the word. Invest in your dentist.

Successful Gummy Smile Repair

After consulting several dentists, our New Mexico patient chose care at the Jacobs Smile Center. She felt that the Reversible Lip Repositioning procedure met her needs best, because she was able to visualize her result before making the final decision to have a permanent fix.

The before and after photos above are taken immediately after the surgical procedure which took about 45 minutes. Patients are able to go about their normal activities immediately after the procedure, and only have to avoid "hard" smiling for a few days.

A fuller upper lip was desired in this case, and it's clear from the photos that the patient's desires were accomplished.

Patients seeking more information about this procedure can send an email to dr.paul.jacobs@gmail.com with a smile photo or two to have a preliminary evaluation done.

Dr. Jacobs is the creator of the Reversible Lip Repositioning procedure, and one of the top providers of the Lip Repositioning procedure in the world.

Connie Blossoms

What an enjoyable moment we shared with Connie today! Her drive to Escanaba was uneventful, and she told us that she was more relaxed today and excited to get her treatment completed. Is agoraphobia conquered? No, not likely, but today another battle has been won.


Connie's dental restorations from her last appointment were comfortable, and she has been taking good care of everything that was done for her. She is learning to smile again . . . it's a journey.


Today, we completed removing all the decay from her teeth - saving and rejuvenating her smile! Connie's confidence has been boosted. All that we take for granted, like the simple ability to smile easily, has now been restored. Connie is smiling brightly.




Connie, thanks for the smile. Thanks for the tears. Thanks for the bear hugs!



Most importantly, thanks for reminding us why we do what we do in the dental office. Thanks for allowing us to use our God given talents for what He intended.



See Connie's before photos and story at: http://dentalnation.blogspot.com/2011/03/everybody-has-something.html

Progress Means More Than Teeth

Letter from Connie . . .

Hello Dr. Jacobs, You're an extraordinary man who probably doesn't realize how many people you touch. Thank you for inspiring me...and for taking my case too!

….while mired in the perpetual cycling of this disorder I’d often wonder about why this happened to me and how did I manage such blatant disregard for my smile, etceteras...

I have just read Dr. Jacobs’ blog. Beautiful. Heavy. Humbling. Thank you!

My smile has become collateral damage and as awful as it is debilitating to exist with a disorder such as agoraphobia, I would take it on again because I have come away with more than I started. Dr. Jacobs’ blog has given me solace in re-appreciating that life is a journey and it is time to buckle up and appreciate every aspect of this "stop and go" ride.

I had become a bit jaded regarding life, and how much longer could I get away with telling my son and daughter that people are good and the world’s great, when I wasn’t so sure. Why did I keep making excuses for misguided strangers as well as my very own family?.."they just don't understand" or "they have no experience with this issue." That perception is a lonely place to be.

Agoraphobics suffer in silence and will endure outrageous treatment from the world because, after all, simply reaching the destination was a battle. Avoidance is often mistaken for relief or control. Can you imagine compounding the burden with the fact that you must keep your mouth closed to avoid the obvious? In our culture, our smile conveys so many different messages, and when you can’t utilize your mouth…well, communication is next on the list of things to avoid. Brutal!

An already "fragile" person will internalize the negativity, and tah-dah…perpetual cycling! Communication is essential to getting a sensible handle over the crippling effects of agoraphobia. It took me years of avoidance/neglect, and the destruction of the smile I had been so proud to flash. Recognizing there is something wrong is critical for progress. Regardless of which side of the spectrum you think you are, many would benefit by demonstrating compassion for each another.

My feeling is that I hit the jackpot when I drove the hour and a half (one-way [can anyone say agoraphobia]) to see the Jacobs Smile Center. Honestly, I was a bit skeptical in the beginning. I was somewhat discombobulated because everyone there is so nice. Turns out, they’re even better than that! They’re people who have empathy. Not sympathy (not good), EMPATHY (good). This friends, is why I wouldn't change a thing. Good, caring people do exist and the world itself is inherently good too!

If you’re reading this, then you had to have read the original blog…awe inspiring altruism (good) -Connie

Agoraphobia is not a final "sentence". Connie's second appointment was constructive and successful. Below is a photo taken before we started today, showing the beginnings of a beautiful, confident smile. I was able to share with Connie that not only had she benefitted from the time we spent together dentally, but that my friend who also experienced agoraphobia had been enriched to know she helped Connie.




Everyone benefits when we take the time to share our human feelings and talents with each other. Who would have known that the silent sufferings of one person could serve to begin unlocking the chains that bind another. Actually, silence would have probably gone nowhere. For it is in the sharing that all are enriched - the patient, the dentist and his wife, the dental assistant, the agoraphobic friend. It's true: As you sow, so shall you reap!






Today, we repaired Connie's other three upper front teeth and all of the teeth on her right side. Connie should be smiling well these next few days! Progress with teeth . . . but oh, so much more!

Everybody Has Something

My wife Paula reassured our new patient, "everyone has something." Our new patient Connie presented last week, and was able to share with us that she had difficulty going to the dentist because of her agoraphobia. Her travels from a neighboring town and venturing into a new environment was difficult, but she knew that something had to be done about her teeth.



"Some people are afraid of heights, others worry about getting cancer or losing a loved one. You just happen to have difficulty with new situations, people, and traveling to unfamiliar places." Paula explained to Connie. "Everyone has something, whether you realize it or not."



Connie came for her first treatment appointment today, and did well. She had three root canals done, laser gum removal to get at her decay under the gums, and four teeth built up so they are white and shiny again.



Connie shared with us that she has been ashamed of her smile and of how she has let this go so long. She told us that she doesn't even kiss her husband anymore because she won't let him get that close to her decayed smile. A few short years ago, she had a beautiful smile and felt so much better about herself, but her agoraphobia kept her from maintaining her teeth. They had suffered greatly, as you can see by her before photo.



Connie asked that I share her story with others, and that she is continuing to make progress, both with her agoraphobia and also with her dental treatment. She did great today! At her request, I took this photo so she can have it as a record of her progress and so that it may serve as an inspiration to others. Our ability to take care of Connie is mostly because of our understanding of agoraphobia. Someone who is very close to me has struggled with agoraphobia for years. Few people know this, and fewer understand that someone's hardship can be a comfort to others.



Dear Friend;
It is because of your struggles and sharing your experiences with agoraphobia that I have been able to care for this precious young woman Connie. Without your help and without your suffering, I could never have understood what she was going through or what I could do to improve the quality of her life. You must know that I appreciate you so much and that Connie's life will be enriched more than you can know. Thank You!
God Bless You - Paul

Invisalign Colors Rock!

Invisalign Colors rock at the Jacobs Smile Center in Escanaba, Michigan!

Invisalign straightens teeth with a series of invisible, clear aligners, but what about teenagers who feel the need to express themselves with the colors of rubber bands on braces? Now Invisalign wearers can custom design any shape, size or color to wear on their teeth. The greatest thing about this awesome option is that every two weeks they can change it to something different or just go "wireless" again.



Above is an example of an Invisalign aligner with bling for the holidays using a permanent marker. Patients can even pretend they're wearing the old fashioned "wires" if they want to surprise their friends.

Perio-Pod

Perio-Pod TM Definition: (copyright 2010, Paul Jacobs, DDS)


A perio-pod TM is two or more people that share or potentially share similar oral bacteria, pathogens and/or periodontal risk factors. Inclusion in a perio-pod may affect the periodontal treatment decisions or outcomes for an individual based on the profile of the group.

Above are bacterial profiles from Hain-diagnostics showing the similarity in bacterial profiles between spouses and between parents and their children.

Tolerating a Fenestration

Nancy came for a cleaning, but it had been quite a long time since her last cleaning due to some medical issues she was dealing with. When I examined her, I noticed what is apparent in the photo above (mirrored image). This "fenestration", or "window" through her gums was caused by slow, steady pressure on her gums from an ill fitting removable partial denture.

The term fenestration comes from the Italian word for window: finestra. Through the window, you can see the roots of her lower front teeth. She also has clefting on a couple of her teeth. This is similar to a fenestration, but communicates all the way up to the crown of the tooth.

An unusual cause for this fenestration was the fact that Nancy's partial put pressure in that area, and she just tolerated it. I guess you can tolerate alot when it comes at you slowly. As her lower partial settled down in back due to slow bone loss in her lower jaw, her partial rotated down and forward behind her front teeth. This caused the pressure and loss of gum tissue in that area.

Our treatment for this is to first take the pressure off of the gums from the partial. Today, I placed a medicated liner under her partial which lifted the back of the partial up, and rotated the metal from the partial back and away from this area. She will soon be healing, and returning for long-term relining of her partial. She may need periodontal care for repair of the fenestration, and certainly she will need these teeth cleaned up!

Who Shot the Sialolith?

"I shot the sheriff, but I did not shoot the deputy..." The song lyrics remind me somewhat of the photo I received recently from my brother Peter Jacobs, DDS. Pete practices near me in the small northern city of Manistique, Michigan.

You don't need to live in a large metropolitan area to see unique things in a dental office. This is one that I have never seen, so I thought it might be interesting to others. Pete sent me a photo of a sialolith, that is - a calcareous concretion or calculus of the salivary gland or duct. He had a patient come into his office with a swelling below his chin and under his tongue. On an xray examination, an artifact somewhat like a tooth was present. After some investigation, Dr. Pete made a small incision under the patient's tongue, and out popped what you see in the picture. The sialolith looks somewhat like a tooth that is tapered on each end. Over time, calcium deposits can build up in the salivary duct, and start to obscure it, causing a backup of saliva in the gland.

Note the size of the sialolith in comparison to the bullet laid alongside it in the photo. My brother is very passionate about hunting, and happened to have the bullet nearby to easily use as a size comparison. He says it's a 30.06 shell. I'm waiting for the deputy to confirm that!

Lip Repositioning - A Reason to Smile

Jean was in today for her final "glamour shots" after her lip repositioning surgery. In both photos, she is forcing a large smile. The "after" photo shows a beautiful result, and she's most pleased with it.

Jean says that she's smiling all the time! It's hard to believe that she wasn't smiling all the time before.

NEW PHOTOS! Temporary Lip Repositioning at:

http://dentalnation.blogspot.com/2010/09/reversible-lip-repositioning-surgery.html

Overcoming 1980's Dentistry

Hey, the 80's called. They want their teeth back!

When I first started practicing dentistry in the 1980's, the most common, least expensive thing we could do for someone who had a large space between their front teeth was to fill the space with two large crowns.

Quickly, we realized that running around flashing two humonstrous chiclets wasn't exactly sexy.

Our next generation solution for this problem was to crown the front four teeth instead to divide out the extra space between more teeth. This worked better, but the teeth generally owned two faults: They looked wider than they were tall, and there was a funny shape to the gum tissue beteween the two front teeth due to missing tissue.

Enter the 2000's . . . Contouring the gingival tissue to make the teeth look larger, and to create a natural "emergence profile" combined with fabrication of murano veneers and crowns really produces a smile that shines on. The gum tissue is contoured with a laser to simulate natural gum contours and "points" between the teeth. Murano veneers and crowns are computer designed to capture natural size and shape relationships between all the smiling teeth.

The photos above illustrate a recent success at the Jacobs Smile Center. The before photo shows the 80's style dentistry, while the after photo highlights what can be accomplished with the technologically superior murano veneers and crowns and laser recontouring - gum lift - of the tissues. The photos have been taken about 3 weeks apart.

Oh, yeah, I also did some ZOOM! whitening to round out the brilliance of her smile.

This lady is very active publicly, and tells me that many people have commented on her beautiful new smile. "I can't believe I waited so long," she tells me. I'm glad it was worth the wait.

Love it to Death

I talked to Bryan last night (Harvard School of Dental Medicine 2010) and he had an interesting case. He had recently restored a tooth for one of his patients, and the patient returned with much sensitivity. On evaluation, Bryan noticed that the new filling was showing signs of wear already. He asked the patient when it bothered her and she replied that it hurt when she flossed around it. "How do you floss?" he asked. She replied that she occasionally wrapped the floss all the way around the tooth like a lasso. Since she was having a little sensitivity in that new filling, she was not only wrapping the floss completely around the tooth, but she was also "crossing" the floss and then stripping it back and forth. This was remarkably like using one of those pocket chain saws that you can buy in Cabellas for removing small limbs from a tree in a minute! Bryan told her to stop abusing her tooth that way, before she had worn the tooth out completely.

I told Bryan "she was loving it to death". He chuckled, but that is how I have described this phenomenon over the years. I will frequently have a dental patient that presents to the office with a complaint of a severely receding gumline on one or two teeth. For some unexplained reason, the gum tissue continues to move further and further away from the tooth. I have learned over the years that when someone focuses on a percieved problem, they may concentrate all their efforts on it. When questioned, the patient usually relays that they are concerned about the recession and that they are "cleaning it really good several times a day so that it doesn't get worse." I tell them that they might be "loving it to death." In their attempt to keep the area healthier, they are in effect causing great damage and trauma to themselves. They think that more is better, but in these cases they need to stay away from the area to let it heal.

I cared for a man about 20 years ago who was losing weight at an alarming rate. His doctors were dumbfounded and couldn't explain why this man was dying a slow inevitable death. He told me that he was a religious man, and that he had visited Lourdes France a couple of years before to pray for good health. He had believed that the healing waters of the fount were alkaline like peroxide water, and thought that the healing waters were not of God so much as they were in the chemicals in the water.

He said, " I use that water every day, and I'm still losing weight. I can't figure it out?" I asked what he meant by using the water every day? He explained that he was mixing up some peroxide and water every day, and bathing in it like at Lourdes. He was also drinking a quart of that peroxide water every day. "I am consumed by this healing water, so I have to get better soon."

I told him that this was not healthy, and that if he kept drinking this water every day like this, he would do great damage to his body. I spoke with his wife, and she also had been trying to tell him this - to no avail.

God rest his fragile body. He loved himself to death.

With Knowledge Comes Responsibility

I have kind memories of the old days in dentistry. There was no HIV-AIDS. Gloves were optional, and masks were mostly unthought of. My father owned one periodontal probe he had received in dental school, and the sum total of knowledge about gum problems was neatly compacted into a one eighth inch thick pamphlet. I'm talking about the dentists' knowledge, not just a patient brochure.

When I graduated from the University of Detroit Dental School in 1983, that small pamphlet of facts on gum disease became three hard covered books an inch and a half thick on the principles of periodontal diseases. We certainly had more to know, but the treatments for periodontal disease were essentially the same. Unfortunately, until about 5 years ago, the only difference in treatment procedures for gum disease was that dentists and hygienists were greater proponents. There was greater emphasis on the diseases, but most treatments remained the same.

Enter 2009 - with the advent of DNA testing and bacterial testing for periodontal bacteria, we have turned a new page in the treatment and responsibility for treatment of periodontal diseases. When our patients reported for their dental cleanings in the past, we may have noticed that they had swollen gums or bleeding when we probed their gums. Our general solution was to scold them that they had to floss more and see us more regularly. Most people were agreeable, as they weren't really flossing like they should have. Six months later, they would return with the same problem.

Really bad cases got sent to the gum surgeon. The usual procedure there was to cut away some of the swollen gum tissue, put the patient on more frequent maintenance appointments, and to scold them that they had to floss more. Every five to ten years the surgery might be repeated as long as they still had some teeth left.

Newsflash: I've tested several hundreds of these so called non-flossers over the past year for the possibility that they might be actually infected by a known badly pathogenic bacteria. Results of these tests have confirmed harmful bacteria present in all but one case. Eyeopener #2: I've tested about 21 couples or family groups in the past 3 months, and have found that each group shares an almost identical amount and type of harmful bacteria in their mouths.

No longer are we able to treat our patients with periodontal disease as individuals. There is such a strong correlation between close individuals and their periodontal bacteria, that we now need to look past just the individual.

With Knowledge comes responsibility! When I see Mr. Jones' bleeding, swollen gums, I have to take into account the health of Mrs. Jones. The children of parents with gum diseases need to be watched more closely. As dentists and hygienists, we can no longer deny the health of other family members in making treatment decisions.

Except for the introduction of technology like lasers and ultrasonic scalers, many of our periodontal treatments remain the same. However, the emphasis on who we treat has moved past the individual in the dental chair at the time. We all know to change our toothbrush after we get over a cold or the flu. It's not as easy to change a spouse, partner, or child just because they are infected with one or more of the harmful periodontal bacteria.

Will dentistry move toward the model of "group therapy?" I propose that this may be what we find in our future. More on this as it develops.

Destiny: Dentistry

At the mature age of 3, I remember accompanying my father to his dental office on Saturday mornings and waiting impatiently while he treated a dental patient or two. To help the time pass, he would drill little holes in plaster teeth and let me fill them with amalgam. When my younger brother was old enough to come along, Dad would let me drill the holes and let him fill them. When I was twelve years old, I worked in Dad's orthodontic office doing all the tasks that I could legally perform. I fabricated plaster models of teeth and orthodontic retainers. I hand drew cephalometric tracings on lateral head x-rays, and wrote out long hand diagnoses of orthodontic treatment plans. My great uncle was a dentist, my father, my uncle, my cousin, and subsequently, my brother became dentists. I was destined to become a dentist. I never considered another vocation. Luckily for me, I LOVE dentistry. I am passionate about it. I always have loved it. What better subject to write about than your passion?

My son Bryan is in his third year of dental school. I hope that he has the same passion and understanding of dentistry that I have enjoyed. My hopes are that this weblog will serve as an encouragement to him about the beauty and enjoyment of the practice of dentistry. My additional goal is that this blog may enrich the life of some young dentist, or quell the fears of an anxious dental patient. My plan for this blog is to bring insight into dentistry for all who have dentistry as an interest. As a third generation dentist, who is looking forward to seeing the fourth generation around the corner, I'd like to give all an inside view into that love that we call dentistry.