Expressive writing

Getting good ideas seems to be difficult especially in these day’s corona virus circumstance. The number of patients per day and the profit had gone down since the outbreak of the virus. They are recovering now, but far from those before corvid 19. It is painfully stressful, and seems to be difficult to get out of it.

Today only 2 patients will come in the afternoon, 14:00 to 14:30 and 18:00 to 18:30. The problem is how I can handle the time between them. It is nonsense to do net-surfing unintentionally, which means waste of time. How to deal with the vacant time? Our time is limited, so it is necessarily to be creative and have new ideas with limited resource.

Expressive writing, which is writing your negative feeling randomly for 8 to 10 minutes without pose after work or before going to bed, is said to be helpful to be creative and to reduce your stress as lots of psychologists recommend. You don’t have to have positive thinking. Honestly, I am introverted. Psychologists say an introvert should not apply positive thinking, because it will make your state of mind more miserable and devastated. Immerse your mind to something different from your present problems sometimes makes your stress less and you can be more creative and may get new ideas to get out of the suffocating feeling in daily life.

Forgetting the things before the turmoil and accepting current harsh situation and being creative, not positive, and hopefully improving imagination and finally getting some new good ideas to survive and thrive in this crisis is my desire. The ideas which will appear in my mind should be applied and tested lots of times. And we should evaluate them if they are effective or not, then do the same procedure one after another.

Learning psychology and applying it in daily life is what I have been cautious of these days.

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.



People all over the world except for some politicians and
bureaucrats are in predicament. We are surrounded by the virus hoax. When will
the state of emergency in Tokyo end? I’m getting cabin fever because of hunkering down. Will I forgo a pay for a while until then?
100,000 yen bounty for one person from the government is a drop in the bucket for almost people,
though it’s better than nothing.
I am despondent over the order I should not carry out dental implant
surgery in the current situation. She (my patient) missed her upper 6 front
teeth because of a traffic accident! For her, it is really the state of
emergency, losing esthetics. No brainer.
However, I admonish myself, saying in my mind, sort of incantation, “Pull
yourself together when the chips are down. Don’t be despondent over hardship. Your
focal point is analyzing past and present about your business, preparing for
the future, in order to mitigate obnoxious antsy feeling. Do not be tipsy. Don’t
waste your time, money, and opportunities.”


Checking a result of tissue regeneration surgery


There is no cure for corvid19. You just have to let run its course, which makes us antsy. If I don’t get out of this situation, I’ll go stir crazy. After this ceases, I should be raring to go.
2 weeks ago, the government declared the state of emergency in Tokyo. This morning, a patient, for whom I have been treating gum disease,
came to my clinic.  I carried out tissue regeneration surgery for her 5 months ago. The
surgery needs a substance called “Emdogain” which was developed in Scandinavian countries for
recovering lost tissues around a tooth. It is applied on the root surface of
the tooth. After the surgery, it is required strict plaque control.
I was worried about the level of her plaque control becomes worse, while she
doesn’t come to our clinic for fear of the corvid 19 turmoil. Fortunately, I found out her plaque control was better than I thought, so healing condition was good. Today’s X-ray shows recovery of lost bone, meaning successful regeneration
of bones between the premolar teeth, though it’s only 5 months after the surgery (In order to get full recovery, they say it takes 6-12 months). X-ray is
just a 2-D image, so I am going to check 3-D structure by CT scan a while
later. When I learned and started tissue regeneration therapy 9 years ago, in each time, I checked if new bone generation was achieved by another open flap surgery 1 year after the operation, meaning directly watched new tissues.
Recently, considering the reopening flap surgery gives some discomfort to the patients,
I check the results only by CT.
 In this case, the patient had missing molar
teeth which caused excessive load to the existing neighboring premolars. The major reason of
lost supporting bone is infection by plaque. In addition to this, the increased
loading may cause the phenomenon. For missing molars, I carried out implants
treatment. The premolars, to which I performed tissue regeneration surgery, are
covered by plastic temporary crowns now. Fundamental rule is final crows should be
applied at least 6 months after the surgery, so I am waiting for the time.
It may be a trivial successful experience,
though I can’t say it is complete success yet, I felt excited and a sense of
fulfillment, because my character may be simple. However, I may forget it
tomorrow and will pursue another success.
 In this case, I performed minor orthodontic
treatment, which was intrusion of an upper molar using mini-implants to create
space for lower molars’ implants (2 pieces), the opposite side in mandible (2
pieces of implant), an upper front tooth implant, and tissue regeneration
surgery in other 2 parts. The treatments which still are not carried out are final
crowns and micro tissue regeneration surgery in 2 other parts, which requires microscope, micro scalpels and delicate skill. The process to the goal is enjoyable, however, it
will be delayed because of corvid-19 turmoil.  


Challenging case

Recently, I had a patient who had trouble with dental implants which his former dentist had embedded. At first, I rejected to treat him. Because, the implants were different from ones which our clinic dealt with. I use implants produced by Straumman co. which has been used worldwide. I did not know the product maker of the patients’ implants through the appearance and X ray images of them. It is said that there are over 50 implant makers in the world. Some new companies aim niche in the market, struggling to keep up with the technology of the companies already having big share. Sometimes, some companies’ implants have kinks though they say their product are fool proof. I wanted to pull out the patient’s implants with counter clockwise strength, because they were poorly positioned. Of course, considering patient’s agony, I can’t carry out it. He asked me to treat many times, and finally, I gave in. Now, I am enjoying the process of reconstruction of his occlusion.



(It’s like night and day, isn’t it?)


 X-ray at the first visit

Pontsuku, Kokura’s sweets




Kokura is a smaller than Hakata (the capital
city of Fukuoka) but growing town in Fukuoka prefecture Kyushu Japan. Since
last September, I have attended a dental seminar held in Kokura, every second
weekend in each month. Last week, before going there from Tokyo, a dental hygienist turned to
me, “Doctor? Please buy souvenir for our staff”.
She is
called as a sweets commentator in my office. She gave me a list of sweets made in
Kokura. It seems that she researched all day long on the Internet. Considering expiring date of the sweets, I chose Pontsuku (photo) which an old
established store has made. It is a sponge cake including custard cream. There
are other versions of cream, such as powdered green tea, chocolate, and
strawberry. It was amazing, fluffy, fabulous and yummy. All our staff turned cartwheels. When you have a chance to visit Kokura, try
Pontsuku, the awesome sweets!



10 years after sinus floor augmentation


I sometimes encounter patients who don’t have enough bone in upper molar teeth missing area for placing dental implants. I learned skills of sinus floor augmentation, surgery of growing new bone in sinus for upcoming dental implants surgery, at University of Michigan in 2002. The reason for going abroad was that I could practice the skills using cadavers in US, which has been prohibited in Japan. Since then, I have overcome the difficulties in placing implants in upper molar. This is one of such cases, CT scan images after 10 years showing stable condition. The more I learn, the more I can contribute.

The boys in the boat


When I was a university student of faculty of dentistry, I belonged to the rowing club. When I was 4th grade, our crew, coxed four, won a race in Japan and selected as a representative of Japan for university students Olympic, held in Italy in 1982. My position was number 3, role of engine in coxed four. We got 4th place in the final heat of 2000m, failed to get medals. After oarsman’s era, I coached younger generation for 10 years. I learned not only skills of rowing and coaching, but also leadership. I grew good relationship with the team mates, all are dentists or doctors now, and still have meeting with them, enjoying talking and drinking occasionally. “The boys in the boat”, describing Washington university crew winning gold in Berlin Olympic, is the book of rowing I encountered since “True Blue” dealing with the story of Oxford university crew’s turmoil and winning the boat race in the end. It was a really page turner. I was moved to know how gung-ho the students were in those days namely Great depression, paying tuition by themselves through working in a quarry or a night pub after home work. The book gives energy to live.



Making sushi with warm heart

Dr. Kasugai, who is a professor of the dental implant section of Tokyo Medical and Dental University, invited my clinic’s doctors to “Kanpachi”,one of famous sushi restaurants in Tokyo (Dinner time;15,000yen~). Many Japanese like to eat sea urchin, but I don’t.  Nevertheless, I could eat one with pleasure here for the first time in my life. Other kinds of sushi and sake are all the best. The master, Mr. Yamada, is 81 and has kept this restaurant for 50 years. He can speak English and has some non-Japanese guests, so if you have a chance to come to Tokyo, it’s worth enjoying true sushi here in Kanpachi. The photo is his autobiography titled “Making sushi with warm heart”. The restaurant is 5 minutes walk from Okacimachi station. Tel:03-3832-7357


The heart of a leader

A friend of mine sent me a book “The Heart of a Leader”.

You don’t have to start from scratch, but read any page you like. The most impressive page for me is the page 62 “Never give in! Never give in! Never give in! Never!”-Winston Churchill. I will re-read this book in a daily commuting train until each word soaks deep into my mind.