Contribution

How to contribute to other people? Being helpful to others is worthwhile for living. They say three forth of people hate their jobs. Luckily, I love my work. As a dentist, treatments for patients are contributions themselves. Clocks are ticking and my days as a dentist are numbered. That’s what I am thinking after birthday of 60.

I have been working at the biggest business town in Tokyo. Because of Corvid 19, the number of patients has decreased to 70 percent. Business person are working at home, not at office. They come to their office only once or twice a month. They changed their dentist near their home instead of coming here.

But I have a few patients who watched my clinical case reports and read my blogs and wanted my skills, saying “I want my devastated teeth fixed like your cases in the homepage”. That’s my big motivation to work. They come from countryside by train, contrary to the office workers around here. Consequently, I have lots of time for them, enough explanation, treatment planning, and of course treatments themselves.

A female patient came and rejected surgery which I proposed, at first. But, she gradually changed her mind and accepted my proposal through many time’s conversation. She will have the best quality of functional chewing by the surgery, I believe.

I am not sure what the future holds for me. However, I will keep learning and control what I can control, not focusing on uncontrollable things such as the coronavirus and the number of patients. Be patient for patients.

before and now

before and now
pink arrow indicates missing teeth area which needs sinus lift before implants

before and now

during sinus lift

before and just after sinus lift

Intrusion of an upper molar

Leaving missing lower molars often makes upper molars extrude. Because of not enough space, making crowns on dental implants is impossible (far left photos). Applying mini-screw type implants for orthodontic treatment enables to push extruded tooth back (center photos). 5 months after the start of the intrusion treatment make the patient get enough space for the finishing crowns on the dental implants (far right photos).

GBR in a front tooth for incoming dental implant

Guided bone regeneration (GBR) is one of the most exciting topics of mine in dentistry. Istvan Urban is a Hungarian dentist who is the most famous in this field. I wonder if he can hold his seminar in Budapest now. Because of corona virus, Hungary seems to be shutting down people from other countries. My friends went to go there in Japanese dentist’s tour 2 years ago. I missed the chance.  His papers The amount of new bone by the surgery of Dr. Urban looks so huge. The key point to succeed is release incision, especially in back side of upper lip. Ordinary release incision cannot make good primary closure of gum. Horizontal and vertical ridge augmentation in upper front teeth area is the most challenging surgery. Some videos in YouTube are uploaded showing introduction the Urban institution, short lectures, and European osteointegration congress. The time of each congress video is 1 to 2 hours, which makes me have a little expectation of getting useful information for free. I could watch a few seconds of release incision in an upper frontal vertical and horizontal defect. However, I could not get a real key point of  the procedure in detail, which only dentists who attend his seminar can learn. The case above is my single tooth implant case which required GBR before inserting an implant. The membrane which covered bone graft was exposed after the GBR, which didn’t affect the result at all.

Helped by system 2

According to the international bestseller “Thinking, Fast and Slow” by Daniel Kshneman, psychologists have been interested in the two modes of thinking evoked by multiplication problem. The two systems in the mind are referred to System 1 and System 2. System 1 operates automatically and quickly, with little or no effort and no sense of voluntary control. System 2 allocates attention to effortful mental activities that demand it, including complex computations. The operations of System 2 are often associated with the subjective experience of agency, choice, and concentration.

When I have a new patient, I sometimes am trapped by the first impression to him or her. And I judge character of the patient and decide if I will treat only the part he pointed, ignore other problems, and finish ASAP, or make a treatment plan of whole mouth after solving his initial chief complaint.

A guy, aging nearly 70, came to my clinic, showing a grimace with pain. He said he went to a dental college hospital because of an acute pain in his lower front tooth. The pain didn’t subside after the hospital’s treatment. By his wife’s introduction, he decided to come here. After all, the problematic tooth causing his pain was not one treated in the hospital. I treated a neighboring tooth which had pus at the edge of root. After the root canal treatment, eventually the pain subsided. He looked like a fastidious guy and my intuition, namely my system 1, worked dominantly in my mind, made me think I should finish and will not do further treatment to avoid emotional trouble.

But, a dental hygienist who is experienced and competent looked at his memo pad filled with lots of schedules, when she made his next appointment after the first visit. She told me that he must be a household name and I should research Wikipedia. She was right. My system 2 began to work and found that he worked in Ministry of Foreign Affairs, engaged in Scandinavian, became a professor of a private university, is an author of international relationship books, and is working as a commentator in TV news program.

After the root canal treatment and subsequent erase of the pain, he showed trust and asked full mouth treatment, and accepted my treatment plan which includes sinus lift, implants, and prosthesis for natural teeth, as you can see photos and X-ray. He was impressed and satisfied to see the before and after photos.

If I had not had the dental hygienist’s attentiveness, I would have missed a chance of full mouth reconstruction which inspires my imagination and creativity. Without her precious advice, I couldn’t have got the successful case.

The problem is when I must activate my system 2 in decision making, avoiding bias caused by system 1. I’m going to study psychology more to solve the problem, to make a better decision.

Passion to save my friend

In a national bestseller book “Awaken the giant within”, Tony Robbins said “I had a hard time giving credence to a doctor who was counseling patients about health but he, himself, was forty pounds overweight” and came across as a caricature where a fat doctor says “You need more exercise. Go and get me a cheeseburger with onions” to his patient. “Physician, heal thyself.” “It is a good doctor who follows his own prognosis.”

From a dentist view, I suppose many doctors, except for dentists, don’t care about their teeth. I wonder if it can be said for only Japanese medical doctors. My high school era’s friend was one of them. He is a handsome and smart guy who was a surgeon and now is working as an adviser dealing with medical law suits in an insurance company. He lost lower molars when he was late thirties. He came to my clinic for the first time 5 years ago. However, he did’t want an implant, but a removable denture which was not used in the end. Probably, he doubted the reliability of dental implant through some dental law suits. Then, he came once again last year. His chief complaint was smell caused by the fracture of upper front teeth. He wanted another removable denture after extraction of troubled teeth. Several days later, he said “This denture is awful, unbearable, I can’t talk clearly when giving lectures. Carry out implant treatment in the upper front teeth”.

I made Power Point slides explaining it’s necessary to have implants in the lower molars to save the upper front teeth implants and other natural teeth, showing force mechanism. I didn’t use any psychological persuasion skill described in a book “Influence: Science and Practice” by Cialdini, R.B. I just used my passion to save his dental condition. He looked impressed by my explanation and accepted my treatment plan.

He smiled and said, “I’m so happy to be able to enjoy eating” after the treatment. I was also happy to contribute to the quality of his life. Maintenance and periodical check-ups are necessary. However, I haven’t seen him since then, probably, because of the new coronavirus predicament. I must pull myself together and face up to the threat.