⬇️ Below the Gumline
Money Shame in Dentistry — why we avoid talking about fees.
Dentists can talk about perio charts, occlusal schemes, and ceramic fracture rates without breaking a sweat. But bring up money, and suddenly everyone clams up. We tiptoe around treatment plans, soften our language, and act like fees are a moral failure instead of a business reality. The truth? You can’t serve patients well if you’re financially anxious. Patients feel that energy. This week, challenge yourself (and your team) to talk about money with calm confidence — no guilt, no apology.
🔥 High-Speed Chatter
💀 More dentists are dying by suicide than ever before. A sobering reminder that our profession needs more open conversations about mental health — not just CE credits. Read More >
🚨 Mesa dentist caught in undercover sting after allegedly soliciting a “teen.” It’s a bad look for all of us — and a reminder that reputations can vanish faster than composite dust. Read More >
🧬 Frontiers study connects oral health to whole-body inflammation. The microbiome conversation just got louder. Read More >
🪥 Dentist deletes hygienist’s clinical notes — and denies SRP. That’s not “managing your chart,” that’s asking for a lawsuit. Read More >
💻 Another DSO hit with ransomware. Because apparently HIPAA isn’t scary enough already. Read More >
🧑⚕️ The hygiene standoff continues. Dentists and hygienists are clashing over production, autonomy, and burnout — but the solution isn’t war; it’s communication. Read More >
⚖️ Dental assistant accused of sex crimes faces trial delay. Sometimes “justice moves slow” is an understatement. Read More >
🪧 Hygienists plan rally in Washington, D.C. to defend educational standards — proving once again that hygiene has backbone. Read More >
💰 Medicaid cuts are coming, and they’ll hit small practices hardest. Time to review your payer mix before the “Big Beautiful Bill” turns ugly. Read More >
🧪 The Research Says
⁇ The Question: Should you leave caries behind?
⚖️ The Evidence: A 2021 Cochrane Review found that selective caries removal (leaving softened dentin near the pulp but cleaning the margins) had the highest pulp vitality and lowest exposure rates compared to complete excavation. Stepwise removal helped, but added unnecessary re-entry and risk.
“Selective removal offered the highest pulp vitality and lowest complication rate.” — Cochrane Database, 2021
The ADA’s 2023 guideline agrees: remove decay at the periphery, but leave affected dentin pulpally to avoid exposure. Once sealed, remaining bacteria go dormant. The key predictor of success? Seal quality — not dentin hardness.
“Once a well-sealed restoration is placed, remaining bacteria become inactive.” — JADA, 2023
RCTs and meta-analyses (BMJ Open 2019, JDR 2013) all echo the same finding: pulp survival rates top 88–90% with selective removal, while full excavation leads to more root canals and post-op pain.
The Answer: Yes — leave it behind if the tooth is vital and asymptomatic. Selective, single-visit removal outperforms the old “clean it until it’s hard” approach every time.
The Application:
Clean margins only. Stop when dentin turns leathery near the pulp.
Disinfect, line, and seal with a durable bonded restoration.
Skip re-entry — the tooth will heal under a perfect seal.
The science is clear: it’s not about removing decay — it’s about sealing it out.
💰 Business Bites
💰 Automate one headache this week.
Every dentist has a task they secretly resent — payroll approvals, EOB posting, reminder calls. Pick one thing and delegate or automate it this week. You’ll free up mental space, reduce errors, and prove to yourself that systems > stress. Once you do one, the next is easier.
🤯 Productive Pearls
⚙️ Only diagnose dentistry you actually enjoy doing.
If fillings make you miserable, it might not be the procedure — it’s the type you’re diagnosing. Start saying no to the deep, isolated, barely-accessible ones, and focus on ideal, efficient restorations. You’ll move faster, enjoy your day more, and stop dreading the handpiece.
💉 Mental Anesthesia
This is about as productive as I remember dental school being……
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