Risk Mgmt

Message in a Bottle Mailbag: Avoiding complaints, treating lip biters, a baseball glossary, and the Super Bowl

Feb. 9, 2015
In this column, Dr. Joshua Austin, Editorial Director of the Product Navigator, responds to product questions submitted by readers.

The "Message in a Bottle Mailbag" is a monthly feature of the e-newsletter, Pearls for Your Practice: The Product Navigator. Each month, Editorial Director Joshua Austin, DDS, FAGD, answers reader-submitted questions to help you navigate your dental and hygiene product decisions (and more!). This month, he offers some suggestions for avoiding complaints, describes some treatment options for lip biting following local anesthesia, provides a glossary for his baseball rating system, and comments on the 2015 Super Bowl.


P.B. wrote: “What's the number one cause of complaints to dental boards? What can be done to avoid complaints?”

Thanks for the submission, P.B.! I am, by no means, a risk managementexpert. There are probably a thousand people who are more qualified to answer your questions than I am. Since this newsletter and mailbag are focused on dental products, I will lean my response in that direction. First of all, maintaining open, healthy lines of communication with upset patients is tremendously vital in avoiding state board complaints. I asked a couple of buddies who serve on state boards about this, and they told me that not all complaints are related to dentistry. For those that are dentistry-related, I can recommend a few tips to keep your dentistry as ideal as possible in order to help you avoid issues that could lead to complaints.

1. Stick with quality, brand-name products with solid track records that offer access to technical support.
You might be able to save a few bucks by choosing generic resin cement, but when crowns are coming off left and right, you will have no one to call for help. 3M ESPE, Ivoclar, Dentsply, Kerr, and others have extensive libraries of data and technical support, and you can just call them. You might pay a bit more, but at the end of the day, it’s worth paying for something that is essentially becoming a part of a human body. Also, avoid using products after their use-by dates. Products are labeled with those dates for a reason. It would look really bad for you if, somehow, an attorney figured out that you were using expired material.

2. Read the directions.
I know it may seem elementary, but please read the instructions that come with your dental products. I learn from these every time I read them. Even if the directions are exactly like you would have predicted, reading them will help your technique and justify why we are doing what we are doing.

3. Use a good lab that warranties its work.
I think some problems progress to the point of complaints being filed because dentists refuse to replace broken restorations for fear of paying additional lab fees with no additional profit. If you choose a lab that offers warranties, you won’t have to worry as much if a patient returns with a broken crown. Glidewell, for example, has a seven-year warranty on some of their crowns. Just take a clinical photo of the broken crown and call them to let them know. Don’t know what your lab’s warranty is? Call and ask! Find out what the process is when a restoration fails within the warranty period. If you don’t tell the lab that this crown was first made two years ago and that it broke, no one at the lab will know that it’s a replacement under warranty. Instead, the lab will just make a new crown and send you a bill.

I hope these three tips will help you improve the quality of your dentistry and thereby diminish the likelihood of complaints.


QUESTION: Barbara wrote: “Do you recommend any treatment for lip bitingfollowing local anesthesia?”

Well, Barbara, I guess that depends on how severe the lip biting is. Although probably a rarity, sutures might be necessary in severe cases. Most lip bites are probably way less severe. After the trauma has happened, applying vitamin E oil can speed healing. If it’s inside the wet-dry line, Kenalog in Orabase twice a day can help quicken healing. It’s one of my favorite products for intraoral trauma, ulcerations, etc. To prevent a lip bite from ever happening, you could look into something like Oraverse to reverse local anesthesia after the procedure. Oraverse isn’t cheap, so it’s not for every patient, but some patients seem more predisposed to this type of trauma than others. For them, it might be nice to have a box of Oraverse around the office.


A Faithful Reader asked: “I am a bit confused by the baseball analogies Dr. Austin often uses in his “Pearls” column. For those of use who don’t play or watch baseball, can you provide a glossary of some kind for this rating system?”

ANSWER: I understand that not everyone shares my enthusiasm for America’s pastime, especially those of you from other countries. Baseball, in my opinion, is the perfect game, and it courses through my blood. If I could have any job in the world, I would be the assistant general manager of a Major League Baseball team. Why assistant general manager? Because the general manager gets all the heat, while the assistant general manager gets to work on building the team, sans criticism. One can only dream!

Now, on to the glossary. Let’s see here …

Strike out- This is the worst rating possible, used for a weak attempt at a dental product. I hope I won’t encounter many of these.

Single- This is a decent product that fulfills a certain niche in the practice but is of limited appeal.

Double- This is a good product with more universal appeal that makes some aspect of practicing dentistry easier.

Triple- This is a really good product that could make a significant impact on your practice, either financially or in the quality of dentistry rendered.

Home run- This is a great product that could impact your practice multiple times a week. Once you have a product like this, you won't want to give it back.

Within all of these ratings are some sub-ratings, so to speak. If I say something is a sharp single, it means it is a very solid single, almost a double. This designation is comparable to adding a “+” to a letter grade (B+, A+, etc.). If I say something is a soft double, it’s barely a double, almost a single. This is like adding a “-” to a letter grade (B-, A-, etc.). Within the “home run” rating, there are different sub-ratings, ranging from a solo home run to a grand slam (a four-run home run).

I chose the baseball rating system because I love baseball — obviously — and because it gives me the ability to form sub-ratings ad hoc. With adjectives like “sharp” or “soft” or additional “runs,” I can further distinguish between the different ratings.

It’s a pretty loose ship here. DentistryIQ and Dental Economics don’t meddle in my columns, so what you read is what I’ve written. The baseball rating system allows me to talk about products in a language that’s familiar to me. My apologies for assuming that those terms would be universal!


QUESTION: David from Dallas asked: “Super Bowl prediction?”

[Editor’s Note: Dr. Austin responded to this question on Tuesday, January 20. Later surprised at the accuracy of his predictions, he wrote a follow-up response on Thursday, February 5. His two responses are designated by date below.]

January 20: I love the Super Bowl. It’s my favorite holiday. Yes, the Super Bowl is an American holiday. Like many other Americans, I will fill my Super Bowl Sunday with hours and hours of pregame coverage, while gorging on amazing snacks and complaining that the game is always a blowout or that Katy Perry and Lenny Kravitz are hacks. One of my favorite aspects of the Super Bowl is the amount of amazing prop bets you can place; for example, how long will the National Anthem take, and who will score the first touchdown? So many brilliant ways to flush money down the toilet!

As far as the game itself goes, I can’t remember a Super Bowl during which the line changed so much so quickly in a long time. Seattle opened as a 2.5-point favorite. By lunchtime on Monday [January 19], New England had become a 1.5-point favorite for most sports books, and that’s where the line stands at the time I write this. I guess Sunday’s [January 18’s] performances influenced that. My hunch? Vegas was all set before the game that the National Football Conference (NFC) would be a 2.5-point favorite over the American Football Conference (AFC). After the games, the public must have jumped all over New England with the point. Seeing a line shift four points in 24 hours is not common. I think the game will ride on the health of Richard Sherman and Earl Thomas for Seattle. If Sherman and Thomas are healthy, it gives Seattle a chance to cover downfield one-on-one, while their front four can try to put heat on Tom Brady. As the Giants demonstrated twice: If you can get to Brady, New England is vulnerable. On the other side of the ball, Seattle has to figure out a way to move the ball through the air. Brandon Browner is good for at least one big pass interference and one late hit penalty per game. Russell Wilson needs to exploit him and New England’s safeties if they want to score with New England. Darrelle Revis will take one of Seattle’s receivers out of the game. The good news is that all the Seattle receivers are pretty much the same, so it’s not like the team depends on one more than it does the others. Keep in mind that I am a Seahawks fan, so that colors my judgment. As of today, my pick is New England 27, Seattle 23, with Brady as MVP.

The worst part about the Super Bowl is knowing that a horrid abyss of no sports action for eight weeks awaits the end of the big game. Is it baseball season yet?

February 5:Before the newsletter went out, I reviewed this section and was stunned at the accuracy of my pick. I basically nailed the pick and the MVP. Did I follow my own advice and bet on it? Of course not. Why would I ever do that? The game was heartbreaking. As a Seahawks fan, I am still sort of reeling. The immaculate Jermaine Kearse reception seemed like the nail in the Brady/Bill Belichick coffin. Why would you throw a slant at the goal line on second down when you have one of the best short yardage backs in the game, and you're trying to melt the clock? It makes no sense. Of course, Pete Carroll is no stranger to crazy decisions at the ends of big games. During the 2006 Rose Bowl, he handed the ball off to Lendale White instead of Heisman winner Reggie Bush on a fourth and 1 late in the game. Texas stood up White, got the ball back, and then Vince Young did the rest. Maybe Carroll just loses it with big play calls like that — I don't know. All I know is that, if it were me, I would have handed the ball to “Beast Mode,” bottom line. If I wanted to get cute, I might play action off of Marshawn Lynch and boot Russell Wilson out to run it in. Either way, the ball is not going through the air. Run the ball, get a ring. They didn't, and now we have to debate about whether Brady is better than Joe Montana. He's not. On to basketball, I guess.

JANUARY'S MAILBAG | The Navigator name, 3M ESPE's True Def, and college football playoffs

Editor's Note: Do you have a question for Dr. Austin? Is there a product you'd like to see him review? Or would you like to submit your own "Pearl"? Tweet to @pearlmail or send an email to [email protected]. You might just see it in the e-newsletter, Pearls for Your Practice: The Product Navigator!

Joshua Austin, DDS, FAGD, is the editorial director for Pearls for Your Practice: The Product Navigator, a new e-newsletter from DentistryIQ.com and Dental Economics. He also writes the "Pearls for Your Practice" column in Dental Economics. After graduating from the University of Texas Health Science Center Dental School, Dr. Austin associated for several years. During October of 2009, he opened a solo general practice in a suburban area of San Antonio, Texas. Dr. Austin is involved in all levels of organized dentistry and can be reached at [email protected].