I don't publicly debate or discuss politics... and I want to get that point out up front in this post. The simple reason is because I am going to mention some political aspects & subjects here. The difference that I want to make clear here is that I am using these topics as an example or an analogy. Plain and simple.
My topic for today's post is maintenance. The Oxford dictionary (which is one of my favorites) defines "maintenance" as:
- Cause or enable (a condition or state of affairs) to continue
- Provide with necessities for life or existence
The first is a great one to use with both mechanical and biologic systems, while the second is much better situated for biologic systems only. The point here is that maintenance is *necessary* for both mechanical AND biologic systems to function properly and at the peak of their powers.
Now let's work this into today's post which, by the way, will be a bit longer than normal. In dentistry, the generally accepted number is that in the U.S. about 50% of the population only presents for dental care due to a situation that can be classified as an emergency. Usually that is due to pain, although it also takes into consideration things such as an accident, a tooth that has fractured, noticing a tooth that is "loose", or other situations that the patient considers "not normal" for them.
The reasons that only 50% seek care on a regular basis are many. Probably the two most common in my experience cost and fear. Cost is certainly understandable. Even though it is my profession and my livelihood, I will readily admit that dental care can be expensive. However, I will add that it is generally appreciably more when dealing with an emergency situation.
Fear I also understand. Dentistry is a very unusual healthcare scenario for most people. The human mouth is an incredibly sensitive area. Evolution has provided the body with an amazing array of protective systems. In the years before humans began consuming processed foods, the mouth was the final point of filtration. If something "bad" gets past the mouth's defenses, it is inside the body and becomes much more difficult to deal with. So the mouth was given an incredible plexus of nerves that allows it to feel even incredibly tiny objects. This is a great system for detecting things like foreign objects that should NOT be swallowed, but the downside is it also makes the mouth incredibly sensitive to dental procedures designed to HELP.
Continuing with my thoughts on this, let's now consider the idea of "maintenance". I want to approach the subject from a biology point of view for patients and then I'll discuss the concept for dentists by discussing dental equipment.
The reason I mentioned politics at the beginning of this post is because this whole thought process came out of an article that I read on CNN.com recently. It was an Interview with retired General David Petraeus from March 2022 regarding his thoughts on the performance of the Russian military in Ukraine. He was discussing the fact that the Russian military has done a poor job of maintaining their equipment, both large and small. Because of that, the Russians have suffered breakdowns and meltdowns that have greatly affected their abilities. In addressing the well known problems this has caused for them, Petraeus stated:
I’ve served in mechanized units, with a mix of tanks and armored personnel carriers. And every single time you stop, the driver and the crew members are outside checking road wheels and final drives, pumping grease, topping off fluid levels. If you don’t do preventive maintenance, then you will end up with such vehicles breaking down.
From a patient perspective, maintenance seems as more of a repetitive process of "getting a cleaning" than something from a "maintenance" standpoint. However, let me emphasize from the doctor's perspective, that those appointments are anything other than "a cleaning". We evaluate a LOT of information and structures in those appointments. Allowing yourself to be evaluated twice a year lets your doctor find problems at their earliest stages. That means they are much easier to correct and also, in many instances, they are also much less expensive to correct at an early stage.
Frequently a regular patient of an office will disappear for a year or so and when they return, they will say, "sorry I haven't been in for a cleaning. I didn't have dental insurance so I couldn't come in."
This is always a difficult thing for doctors to hear. The dental insurance companies have done such an amazing marketing job of convincing the public that they *need* dental insurance. The sad part about this for dental professionals is that many times the patient will need either expensive or complicated treatment that could have been addressed with much less expense and difficulty, IF maintenance appointments had been kept. Unfortunately in these situations, the patient ends up paying more to get back to normal than they would have paid if they had kept their biannual visits and paid out of pocket for them. That is not a rant against patients, it is frustration at insurance companies who have managed to convince patients that they NEED insurance and if they do not have it, there is no need to see a dental professional. Yet, I also realize that changing a job or losing a job also could affect income. If the budget does not allow for maintenance, I certainly understand that. Needs have to be prioritized and sometimes that even means kids get appointments while mom and dad wait.
Many times in my career I have had patients return with insurance who present to my care with the need for a root canal and crown, when a simple filling could have easily fixed the problem 2 years ago.
So for those of you who are reading this as patients, please take this into consideration. This might well have an impact on you. What I really want here is for those who can afford to do so, to continue with continuity of care.
Now for doctors... it's a similar situation when it comes to equipment. Often routine maintenance or contracts for it seem like a lot of money spent that is really not needed. However, if you think of the logic of having something break or go out of service, you could very well have to cancel appointments, reschedule, or even potentially close your office until repairs are made. The overhead of a modern dental office is high. Efficiency is great for a lot of reasons one of which is that efficient offices get more done per time unit and that cuts costs.
To turn a well know expression into a business phrase, it is often true "a penny of prevention is worth a dollar of repairs". Keeping your office running well allows you to deliver the quality of care your patients need and that you are capable of delivering. However, you can't deliver that if you don't have the proper means to do so.
Over my career I have purchased many "service policies" or "extended warranties" with the confidence that keeping my office running well was worth the cost. My mentor once told me, "When you prepare for an emergency, it ceases to be one." That was great advice and I apply that one constantly. In the environment of a busy dental practice, there are enough day to day unforeseen problems. You never know when a handpiece will suddenly fail or when an ultrasonic unit in hygiene will not turn on. These things happen. Yet, if you also choose to leave to chance every possible maintenance failure scenario, you are inviting scheduling and efficiency disasters.
It is better to dance with the devil you know than the one you don't. If you spend a little more money on maintenance, the only thing you've lost is a little money. If you are forced to cancel appointments and rearrange your schedule, those decisions begin to impact others... namely your patients. Many people in today's environment can only take limited time from a job for dental care or they may have to rearrange their life just to find a baby sitter. When these folks have to rearrange their lives due to an appointment being rescheduled, it becomes the analogy of a rock being tossed into a pond and you have no idea where the waves go or what their effect will be.
In a nutshell, everything in life goes better if maintenance is planned into it.
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