AME: Clinical Rage Bait

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[00:01:13] [SPEAKER_00] Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement. Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before, I give you the Alan Mead Experience.

[00:01:32] [SPEAKER_00] Well, hello and welcome to another episode of the Alan Mead Experience. I'm your host, Dr. Alan Mead. I'm a dentist, podcaster, and an assembler of dental equipment. Today I am. I'm actually coming to you from my office. It is a Sunday. It's a Sunday before I'm going to see this episode. I'm here assembling a new part for some new equipment that I just got that perhaps I will be reporting about.

[00:02:01] [SPEAKER_00] I'll keep you posted. So I am currently that guy who is attempting to follow instructions like for any kind of assembly that you do normally. I only laugh because I'm the guy who wants to try and do it without instructions. And so I've tried multiple times. I did okay. I did. The cart came together pretty well. The rest of the equipment, we shall see. I'll keep you posted.

[00:02:28] [SPEAKER_00] But as a guy who started practicing, who owned his own practice in 1998, there have been lots of times when I've had stuff that needs to be done at the office. And for me, it's 40 minutes one way to go to the office. So you don't want to go to the office lightly. You want to make sure you're getting stuff done. So I decided, hey, I could record an episode. I could record an episode of the Alan Mead Experience while I'm here sitting in front of my office computer.

[00:02:57] [SPEAKER_00] So there's this thing that I always notice when I'm at the office trying to get stuff done is that time seems to speed up. There's this very weird concept like this, what I need to do here should not take this long. But somehow or another, I'm looking, it's almost noon. I feel like I've been here for an hour and a half and I don't feel like I've done anything. I don't know that I've actually been here for an hour and a half, but it feels like it. And I'm like up against it because I got to get back home to do other stuff at my house.

[00:03:25] [SPEAKER_00] There's a weird, when you're at the office to do something and there's no patience and you're alone and you're thinking to yourself, this is a great time for me to get a bunch of great stuff done. Time speeds up, man. There's something freaking weird about that. I don't know exactly how it is, but everything, you look up at the clock and you've been here. For two and a half hours and you feel like you haven't got anything done. That's kind of where I am right now. So anyhow, anyone who's owned their own office, particularly if it's a relatively small office and you're a small operation,

[00:03:55] [SPEAKER_00] you could come to the office at any time and there's always something that needs to be done. And you kind of almost have to just turn that, you kind of have to turn that, you have to turn that urge off to go get stuff done because you'll be there, you'll be there all the time. So this is a relatively special occasion. I don't come to the office on the weekends very much at all, occasionally for an emergency patient or something like that.

[00:04:24] [SPEAKER_00] But the reality is I try and avoid that. But I did today and I ran into the time suck or the time warp that you always run into at the new office or at the office when there's always stuff to be done. Interestingly, I moved to this office, this building, 13 years ago like today. It was Labor Day 2013. So that's it's exciting, but it's also kind of wild that like it's again, I practice. Let's do the math here.

[00:04:54] [SPEAKER_00] I practiced for 15 years in the old office. So I've been here almost that long. I'll tell you, man, time sure flies. So I I've been thinking about what I want to do for this episode for for quite some time. It's a little bit silly. It's also kind of fun. There's anyone who's a clinical dentist has probably run into common, dumb things that happen all the time in in the dental office.

[00:05:21] [SPEAKER_00] And it's it's it's the kind of thing that it's the kind of thing that you don't talk about with your colleagues, because instead of, you know, looking cool on Instagram and actually it's usually makes you look like an idiot or or or irritates you or dumb stuff like that. So I it's a little bit of clinical dental rage bait stuff, but it's just sort of funny things that I've put together over time. And I'm just going to kind of I'm going to run it past you. Now, if you have never run into any of these things, then good on you.

[00:05:50] [SPEAKER_00] You're probably more organized and you've thought things out better than I have. I don't know. But there's just lots of little dumb things that that that I've thought about. So without further ado, here's a little bit of clinical dental rage bait. The first one I call Schrodinger syringe. Now, if you are in a specialty that doesn't deal with materials that come in a syringe, you may have you may dodge this. But I want you to imagine yourself. You've got great isolation.

[00:06:17] [SPEAKER_00] You're placing some kind of a direct restoration or maybe you're cementing something and you've got a syringe of material that you need to dispense onto the tooth and your assistant hands it to you. And your assistant, it's 100% your assistant's fault. But also, your assistant is trying to do the right thing here. I actually had this conversation with my assistant. So if she hears this, she won't be too mad at me. But it's Schrodinger syringe. She hands you a syringe that feels like it could be empty.

[00:06:44] [SPEAKER_00] She's trying to get your money's worth out of the materials that you've paid for. But it's typically a flowable composite syringe because I always feel like the flowable composite syringes, when they're brand new, seem like they're half empty anyhow. But there's just the slightest bit of like it looks like it's an empty syringe, but you're not really sure. She's not really sure. So you don't know until you bring it to the tooth and you try and see if there's anything in there.

[00:07:11] [SPEAKER_00] And I have to say, lately, I've won on the Schrodinger syringe situation. Like I've more often than not, in the last week or two, the syringe that feels like it's empty when she hands it to you actually has enough in there to get the job done. I'm typically using flowable as like a lubricant on the preparation. Then I'll use some kind of a paste to follow it. Either snow, you know, they called it the snowplow technique. Or in BioClear, I'll basically put it all together.

[00:07:39] [SPEAKER_00] But the important part is whether or not you have any of that flowable in there. So the syringe, Schrodinger syringe, you don't know if there's really anything in there until you take it all the way through. So you've either wasted the time or you haven't. That is one of the more irritating things. And God bless her. My assistant is trying to make it so she's trying not to waste materials.

[00:07:58] [SPEAKER_00] But it is enraging when you are behind or whatever and she hands you an empty syringe and you're not even sure whether or not it's empty or not. So that's my first one. Now the second one is my first of several glove concerns. I use neoprene gloves. I think we even pay a premium for them because we've tried every kind of non-latex glove out there and we've sort of settled on this neoprene glove.

[00:08:26] [SPEAKER_00] And one of the problems with latex gloves, if any of you are old enough like me where you started out using latex glove, the one thing is that we use latex with powder on them. And the powder would get everywhere. But I'll tell you what, they went on your hand completely. And there was never any air gap. There's never any extra material. They fit your hands tightly and was wonderful. But then latex allergies were a thing for clinicians and for patients. And the powder was also apparently a really bad thing.

[00:08:56] [SPEAKER_00] I'm old enough to remember when we use those typically. So we've moved these non-latex materials. And the non-latex materials are famous for fitting your hand poorly. And I found that, God help you, if your hand is the slightest bit wet, like you've washed your hands, you're coming in the operatory. Typically, you notice this when you're in a hurry, when you're running behind or your hands are sweaty, even that, like you've been working your tail off and your hands are sweaty. God help you trying to get these gloves on.

[00:09:23] [SPEAKER_00] There's no, when they were powdered, powdered latex, man, they'd slip on. Even if your hands were wet, they'd slip on perfectly. But I use neoprene. And the neoprene is probably the best of all the non-latex ones that I've used. And even at that, you'll put them on and they don't always go on all the way. The classic example is you're handling like a single unit crown. You're trying to, the very classic thing is I've literally treated a zirconia crown in the lab. I've got it treated, ready to cement it.

[00:09:50] [SPEAKER_00] And so I go in, I hand the assistant the newly cleaned and prepped crown ready to be cemented after trying. It's all ready to go. I put my gloves on and there's about a half an inch to an inch of material at the end of my fingers. And no matter what I do, I can't get them on any tighter than that. And you're trying to hold on to, with your fingers, this teeny tiny little crown. I mean, imagine you're cementing a crown on number four or whatever. And you've got the, it's basically you're wearing a Ziploc bag on your hands.

[00:10:19] [SPEAKER_00] And it is like, literally, I will have to stop, take a deep breath, which is, I like to move. When I'm ready to go, I'm ready to go. But I have to stop and then I have to decide, okay, can I get this on a little tighter? And so I'll take each finger and try and tighten it. Or worse than that, I'll take the glove off, wash and dry my hands and let them dry until I can get them on tightly.

[00:10:41] [SPEAKER_00] It is, I don't, I would love anyone who's got a recommendation for non-latex, you know, non-latex gloves that will go on more smoothly than this. These are the best ones that I've found and they still, half the time, particularly when I need to handle something, you know, with my, I guess it's not that big of a deal if you're doing surgery. But if you have to handle something really finely, it drives me absolutely crazy. So that's, that one drives me nuts.

[00:11:08] [SPEAKER_00] The next one is the, along, along with those lines, the, you're walking into your operatory. I have gloves right on the wall so I can just grab my gloves as I go into the operatory and I'm ready to pull two gloves out and a wad of 12 gloves falls out onto the floor. And I'm going to tell you what, first off, you know, you're, you know how much you're paying for those stupid gloves. And secondly, I'm convinced that they, they pack these gloves in this way so that you will waste them.

[00:11:34] [SPEAKER_00] The smart money would be to have gloves so that you have to lift them up out of a dispenser so that if they do that, they don't fall on the floor, but ours are on the wall. So if you have a wall-mounted glove box, you know exactly what I'm talking about. And the consolation prize is your assistant also has the gloves mounted on the wall on the other side of the operatory. And this happens to her all the time, too. So you're just thinking to yourself, great, I'm just burning money in gloves that falls out of these things. And it usually happens when it's a new box of gloves. So you, you, you know, they're packed in so tight they want to fall out.

[00:12:04] [SPEAKER_00] Once the glove box is half through, it doesn't do it. So you're also like, okay, do I take these gloves out first so I don't dump them? And then you're like, how sterile or how clean are these? It's, it's a mess. And I'm, I'm convinced that it's, it's done on purpose. And I just always think to myself, how much money am I wasting on these gloves that fall on the ground? We have a new policy now since at the farm, we have lots of uses for gloves.

[00:12:27] [SPEAKER_00] Any of them that fall out on the, on the ground that we can't use on a patient, we'll throw in a Ziploc bag and I'll take them home because I can use them for farm stuff. Like when we're oiling bike chains or, or cleaning stuff up from the farm. And then that way you don't have to be sterile or clean necessarily just protecting your hands. So thank goodness for that. That's been a recent thing that we've thought of doing only because as I was putting this episode together, I just was like all the things that enraged me during the day. I'm, I'm not sure.

[00:12:54] [SPEAKER_00] Maybe this isn't something I should be rolling around in, but it is, it's funny when it's not actually happening to me. So I'm just wondering if any of you have any relation to this, if this ever happens to you. And if it doesn't ever happen to you, I don't really want to hear, but if it does happen to you, I kind of want to hear about it. I want, I want you to say, oh yeah, that happens all the time. So I don't feel like such an idiot. You can go to the Very Dental Facebook group. And if you're not a member, you can join. Just go to Facebook, look up Very Dental and you can throw in an invitation or just click on the invitation.

[00:13:23] [SPEAKER_00] And all you have to do is give me a password. I'll give you one to remember. You can give Timmerman, give me Timmerman. This episode, just give me Timmerman. There's a million passwords I've put out over the years, but Timmerman will get you in. And that way we can talk about the dumb things that happen in the operatory that enraged you. Okay. The next one I have, I have a Garmin. I, I, I use my Garmin for, for cycling. It's right here. See, it's kind of cool. I use it for cycling. I use it for, I use it for walking.

[00:13:51] [SPEAKER_00] I use it for tracking my sleep. Frankly, the whole tracking culture of everything is probably somewhat toxic. I don't know how you hear nothing more than everything about these things, calorie counting and all that. It's super inaccurate, but it's also connected to my phone. And I leave my phone's ringer off. And what's, what's helpful at sometimes is the fact that my phone will vibrate on my, my wrist on my Garmin watch.

[00:14:20] [SPEAKER_00] So I don't ever have to worry about it, you know, interrupting something in a, but it'll just buzz on it. But what's really funny is the amount of phone calls I get while I am gloved up and working on patients. And it's absolutely enraging because first off, I don't want to touch my watch with my gloved hands. So, and second off, I don't exactly know how it works, but it feels like this thing rings for two minutes. And so literally, if I happen to be touching my patient with my left hand, for whatever reason,

[00:14:49] [SPEAKER_00] retracting or whatever, they can literally feel the vibration of my watch through, through my hand into their mouth. And so, and you can even hear the vibrating a little bit is it's super irritating. And of course it's irritating. It's no one that I ever want to talk to during the day. Sometimes, depending on where my sleeve is compared to my gloves, sometimes I can see who it is. Sometimes I can't, it doesn't really matter to be honest, but I just laugh because I'm like, I am the idiot for not turning the notifications off. I leave the notifications on and never change it.

[00:15:17] [SPEAKER_00] So every day my phone will go or my, my watch will go off because someone is, I never answer my phone. Like, unless it's my, unless I can see exactly who it is and my phone happens to be there. I never answer my phone. There's really no reason for me to have notifications on, but I never seem to remember this when I'm walking into the operatory and invariably at the absolute worst time during an appointment, my watch will buzz. And so I don't know if anyone else has like an Apple watch or other, I, this Garmin does

[00:15:43] [SPEAKER_00] this and it's all, it's 100% my fault for a, for owning one and wearing it and be not turning the notifications off. But, uh, it is something that can send me zero to, to super angry and no time flat. I don't, I don't even know why it enrages me so much, but it really does. It's sort of, it's sort of funny. And I'm the idiot for not turning the notifications off. My next item of clinical rage bait is a classic is an absolute classic.

[00:16:10] [SPEAKER_00] So I work Tuesday, Wednesday, and Thursday, most weeks, Tuesday, Wednesday, and Thursday from 7am to 5pm. I take a lunch at one. So it's a nine hour day. It's a pretty long day. I know there's people who do longer. And so that my, my clinical hours are relatively limited. I have a lot of time away from the office, but 7am on Tuesday, man is. You already know crazy dental has practically unbeatable prices on everyday dental supplies. But how do we make that deal even sweeter? Free shipping.

[00:16:40] [SPEAKER_00] Jump over to crazydentalprices.com, fill your cart and enter promo code very ship, all one word at checkout. That's very ship, all one word to wipe out shipping costs on every single order. Even better. Using that code directly supports the very dental podcast network. Stock up, pocket the savings, get free delivery and help back the show. Use very ship, all one word today. Tuesdays are rough. Tuesdays are rough. Like if you've ever had the Sunday night scaries for Monday, just imagine having another day

[00:17:10] [SPEAKER_00] off and Tuesday mornings are, I have to, I have to really, really do better with my mental state on Tuesdays. Cause until about lunch on Tuesday, I'm it, it's a bad, it's a bad morning. Anyhow, imagine showing up for yourself. Well, I get there at, I get there at about 630 usually most mornings. And so that means I leave at about 550 AM. I give myself 40 minutes to get to work. So I rolled out of bed on a Tuesday after a nice long weekend of doing other stuff with my family, my kids doing everything.

[00:17:41] [SPEAKER_00] And I show up, I get in, we do a, we do our meeting at 650 ready to go at seven o'clock and my 7 AM patient doesn't show. I got to say it doesn't happen very often, but when I have a no show, I do, I don't know if it's true or not, but statistically it feels like it's very much more likely to be the 7 AM patient. The reason I say that is because I could sleep in, you know, like if you just would have canceled the night before I would have just come in later and it would have been a glorious morning,

[00:18:10] [SPEAKER_00] you know, like if it was something we can't fill, but if you know, show I'm going to be there and I don't have any time to fill that spot. So we don't have a ton of no shows. We don't have a ton of cancellations. I remember, I feel like maybe because patients know we're not open that many hours, they really don't want to miss their appointments, which I think honestly is a great strategy to make, make your, your hours feel more or less likely that, you know, it's harder to get in because we're just not there that often.

[00:18:38] [SPEAKER_00] Some patients may choose to go to another dentist because of it, but for patients that like us, they know that they got to keep their appointments. I think that's not a bad thing to do. But man, that, that 7 AM no shows are bad enough as it is, but the 7 AM. One where you could have slept in, man, that is a killer. That is an absolute killer. Okay. So I want you to imagine for my next clinical rage bait, I want you to imagine that you're, you're a little bit behind. You've got, you, you've double booked some patients. You have some emergencies.

[00:19:07] [SPEAKER_00] You're really running and then you go in and you're ready to start on your next patient. And it's, it's, you're working on the lower. When exactly do nerve blocks, when do you miss nerve blocks? And my answer always is when you're running behind, when you don't have that much time, the nerve, I can hit a nerve block all day, every day when there's no rush. But as soon as there's any kind of a time, a time crunch, I couldn't, I couldn't hit a nerve block to save my life. It's again, it's a Murphy's law thing.

[00:19:35] [SPEAKER_00] I don't know if it's real, but it sure feels like it's real. It feels like I couldn't hit a nerve block when I'm running behind if my life depended on it. So I don't run into missing blocks that often, but so lately I just have noticed whenever, whenever I'm, I, there's two things. When I'm stressed out because of time or when the patient is stressed out because of anything, anesthesia is the issue. This is where I need to, I need to probably start getting, I don't know if it would make

[00:20:01] [SPEAKER_00] sloppy technique or, or high anxiety patients get number faster, but that whole buffering concept, I probably need to look back into it. But anyhow, it seems like I only miss my nerve blocks when I'm, when I don't have very much time. I only miss my nerve blocks when I really need to hit them is what I'm saying, which is funny and rage bait now, but it's, it's a nightmare. It's a nightmare while you're actually working on patients. Okay. I got another great one. This is much like the Schrodinger syringe from the first part of this podcast.

[00:20:30] [SPEAKER_00] We have Schrodinger's patient. So you've got that. Your policy is that you don't see the patient after X minutes if they're late X, X minutes. And so what about that patient where you're like, man, it'd be great if they didn't come the patient. You don't really want to see. You'd love to have a little time to, to work on something else or, or have a cup of coffee or just chill out or get ahead of your hygiene exams or whatever. And if your number like ours is ours is usually, we don't see people after 10 minutes.

[00:20:58] [SPEAKER_00] If it's an hour appointment or longer. And so at minute about eight and a half or nine, you're wondering, okay, okay. Am I going to get this break or not? And then it's Schrodinger's patient. You know that depending on how much you don't want to see that patient, that's the amount that the patient is likely going to show up at nine and a half minutes and show up. So just when you think you're in the clear and you're going to get that time to yourself or you're going to be able to work on something else, you hear that front door open. And there they are.

[00:21:26] [SPEAKER_00] The patient, the patient shows up, oh God, just thinking about it makes me sick. That's again, perfect rage bait for, for me clinically. It just, and this is like, it's funny because I'm putting all these things in a list, but they happen so, so not, they don't happen that often, but over my career, I've thought of these a lot of different times. And that's why I'm sort of compiling them and all in one silly podcast. So there's another, another one that's, this is for people who do a lot of direct restorations,

[00:21:56] [SPEAKER_00] who do a lot of fillings, posterior fillings, stuff like that. Now, if you've started, if you use a sexual matrix, there's a funny thing, sexual matrix, whether it's like, I love BioClear, I use Garrison for some, and they each have the, the complex is you place a sexual matrix, you place your wedge, and then you, and then you place a ring over top of both of them for separation. So you get these great contacts. I talked about it a couple of weeks ago.

[00:22:21] [SPEAKER_00] And the thing that I find so frustrating, and it's like you, it's like if you had a third hand, everything would be perfect. Like if you could, if you could, I don't, I haven't found that my assistant can help me with this stuff when I'm placing these. You do need a third hand. So what happens is you get your sectional placed absolutely perfectly, just exactly what you want it. And then you, you slide that wedge and you come from the pallet on, on an upper, and it just cinches in there. Just right. You have it just exactly where you want it. You're like, okay, we're ready to go.

[00:22:50] [SPEAKER_00] And then you take the, you take the ring and it has to cinch down along that matrix that in, in the wedge just perfectly. And as soon as you let, let the tension go in the ring grabs hold of your matrix pops up three millimeters or two millimeters, you know that you've unseated the damn matrix with your ring. And this happens often enough. I, I sometimes wonder if it's a, uh, if it's a part of the whole, okay, this is a crazy thing.

[00:23:17] [SPEAKER_00] You'd have to be pretty old to remember these things, but the company that made the V ring and when these sectional matrices were first coming on the matrix, a guy, guy in New Zealand invented this thing called a tri clip. I don't know if you remember tri clips, but tri clips, you take this thing out of a bag. They came pre-sterilized. It was a disposable ring, separating ring, a matrix band in a, in a, uh, a wedge. And it was not like a conventional wedge. It was more like a floss wedge all in one piece.

[00:23:44] [SPEAKER_00] And you would seat it down on the tooth first, and then you'd pull the wedge out and you'd have, you'd have it well seated. And that was one thing you knew it was well seated by the time you let go of it. Cause all of these things were held together. They were, they were one piece and like I, they weren't, they obviously were not the winning solution. I don't know that tri clips are available anymore. I mean, we've moved on to different things. This was 20 some years ago, but the, the reality is it was one thing you wouldn't, if you got it to seat down on the tooth, you were good to go.

[00:24:12] [SPEAKER_00] Now, when you're putting each piece on separately, I find myself dislodging my stuff with that ring often enough. And that is, again, this always happens when you're running behind. It always happens when the patient is struggling to stay open or, or whatever. You're just like, ah. And so you find, I mean, it's common for me to need two or three chances to get that thing seated all the way. And frankly, it's worth going back and making sure it's right.

[00:24:37] [SPEAKER_00] But if you think that that ring dislodged your matrix, it did just, it's true. But if you think it did, it did. So know that, and if anyone has any, any answers that, oh, I figured out how to do this. I want to know, please tell me in the Facebook group. Cause it is, I find this to be nothing short of a nightmare. Every time, every time I've had a challenging matrix placement like this, and then I got to get that ring on. I'm like, ah, I just wish there was some way that I could do it without displacing, you know?

[00:25:06] [SPEAKER_00] And it's, it happens as much with bio clear stuff as it does with a metal matrix. I think it just, it's just somewhat, somewhat classic. I'll say this. If you have a matrix that goes all the way around the tooth, which I use sometimes, you couldn't displace it then because the other side of the tooth would be holding it in place. But that's, that's neither here nor there. Cause I don't, those matrices don't make a very good contact in the same way that sectional matrices do. So just more rage bait for me, apparently. So, and along those same lines, this is the last one.

[00:25:35] [SPEAKER_00] And this one's, this one, I always feel like, I always feel like I'm in a sitcom or like, or, or I'm, I'm being punked or something like that because like, I'll have a perfect rubber dam isolation. And amazingly, I've prepped the tooth and I haven't beat my, I haven't beat my matrix up and I haven't, I haven't beat my tooth up. Haven't beat my rubber dam up. My rubber dam up is in pretty, pretty good shape still. I'm like, this is amazing. Tooth is all ready to go. I'm ready to place my matrix. I place my sexual matrix.

[00:26:05] [SPEAKER_00] It goes right to place. Then I take my wedge and nine times out of 10 or more, it is the, it's a diamond wedge from, from BioClear. I love those wedges. I think they're fantastic, but it doesn't matter what wedge it is. This happens for, if you have a rubber dam on about 30 to 40% of the time for me, I'll get my wedge placed and let go of it. And it pushes out because the rubber dam is pushing it back out.

[00:26:30] [SPEAKER_00] And it is, it, I feel like I'm in a Looney Tunes cartoon because it's like, I placed my wedge perfectly and it's just exactly where I want it. And then it pushes out because the rubber dam has caught on it. You're just like, ah, it's, it's honestly one of the things where sometimes if your dam gets beat up a little bit and, and the, the dam has come in from in between the teeth, sometimes you're like, I'm just gonna leave it because I know for one thing, it's not going to back my wedge out is all of these things are mind numbingly and rage inducing to me.

[00:27:00] [SPEAKER_00] They happen, they don't happen all the time, but I just, I was kind of compiling a list of all the dumb things that happen. You know, whether it's, uh, another one is like the, when you go to the air water syringe and you're ready to, you're ready to just gently dry your preparation and you get water and I'm like, ah, it's one of the reasons I use an air only syringe, to be honest. But I want to hear your rage bait. I want to hear, I probably missed some, I probably missed some really good ones. So I'm going to open up a thread in the very dental Facebook group. I want to hear the dental rage bait.

[00:27:28] [SPEAKER_00] Uh, I want to hear your dental rage bait and we can have a laugh about it because you know, if you don't laugh about it, you might cry. That's kind of where I come down on these things. So, okay, folks, I hope you enjoyed this episode. I wish that you would tell a friend. And with that, I'm going to close this one out. I enjoyed this episode and we'll see you next time.