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Last night I attended the Marquette University School of Dentistry’s Winter Gala. Always a wonderful night and something that my wife and I look forward to every year. And every year Gala is a time for me to see a little more of the human that dwells within each and every one of my students. All too often in life, and certainly right now in dental school, we seem to be railroaded into homogeneity and a lack of humanity: everyone required to wear their class scrub color with no deviations; prescribed uniforms that must be worn in certain areas or there will be repercussions (forget wearing a sweatshirt if you get cold); etc. To me it seems that we put forth way too much work and effort to dehumanize our burgeoning young professionals who will eventually be contributing to and working within a field/profession which is all about human interaction, empathy, and expression.

Winter Gala. One night to see beautiful dresses. One night to see dashing suits and ties. One night for burgeoning professional youth to be free from their shackles for a brief moment so to embrace and experience their fleeting and rapidly changing youth. One night that may be the very last time for D4 students to dance and sing and celebrate their youth as life and adulthood are calling and there is no choice but to be ready to be launched into life and commence practicing within the profession that we faculty have tried so hard (or not) to instill in our young protégés and protégées.

Unbridled youth. Enjoy these days. They are fleeting. Hold on to youth and life for as long as possible. Don’t hasten the transition. Life always moves us on to the next thing and most of the time that next thing in life is a good thing. But when we move on, as life always forces us to do, we always leave a little bit of ourselves in the past.

Gala is a chance for me to relive my days past. Gala is a time for me to live vicariously through my youthful student’s dancing and celebrating. Gala is a reflection back to my days of innocence. Days when I was just Patrick. Yes, I long for those days when people saw me as just Patrick (and not doctor). Yes, I have done the work, walked the walk, and talked the talk that have afforded me a title. But if I always was and am and will continue to be only that which I am then why the title? If doctor is what Patrick was and is then why can’t I just be Patrick? Maybe Gala brings me to this: the bright eyed youth doing that which I was always meant to do and will continue to be.

I miss my youth. I lament the many things that have derailed my bright eyed youth and innocence. Life happens. Sometimes life isn’t fair and doesn’t make much sense. And I am grateful that I get to see my students be the beautiful and youthful people they are especially at Gala. And I am grateful that my beautiful and youthful students daily remind me of where I’ve been and where I can go.

Enjoy these innocent days my friends. There will be good days. There will be not so good days. And if one works hard the not so good days shape us into greater and better versions of ourselves. I wish I could shelter my students from the not so good days but we all must face those days and learn from them so that we may grow into the better people we’re meant to be.

Thank you for last night. I cherish my time with you all.

One of my favorite books on education is Susan Ambrose’s How Learning Works: Seven Research-Based Principles for Smart Teaching. And until reading that book I had never heard the term “unconscious competence” in relation to mastery. And when I think about unconscious competence, it makes perfect sense (at least to me). Dental hand skill professors like myself don’t have to think about our hand skills anymore. Our hands just seem to know how to do whatever our brain says we need to do to prepare and restore (also know as drill and fill) teeth and we do this without much conscious effort (in other words, unconscious competence). However, when we (at least I) look back to when we were twenty two years old and just starting to prepare and restore teeth in our first year of dental school we are reminded (at least I am reminded) of how difficult and awkward and frustrating it was. There were days in dental school when we (maybe it was just me) wanted to scream and pull our hair out yet nowadays we hand skill professors are SO quick to forget those days (probably for survival purposes). But our students are smack in the middle of that struggle. And then we hand skill professors get so forking frustrated and scream and say shit like “they just don’t get it and maybe they’ll never get it…they’re hopeless”. Well now I know why the students don’t get it and why we professors get frustrated at students: our unconscious competence AND our expert blind spot (thank Susan Ambrose and her book for those two terms).

So how do I need to manage my unconscious competence AND my expert blind spot (keeping in mind that I am NOT a course director and have no control over lecture content given to students)? I have to constantly push through my expert blind spot (Ambrose, 2010, p. 112). In other words, I have to be ever vigilant to where the students are in their learning (if I have no clue as to where students are in their learning and development then I am blind to what they know and I am completely compromised in my realizing what I need to give students in order for them to excel). For instance, dental hand skill text books have been around for many years and have been perfected incrementally time and again (I still reference back to my hand skill text books). So I always need to be aware of student’s required text readings and what the text book’s author(s) have suggested. My course directors work hard to develop and present lectures in concert with the text book readings. So I always try to attend lectures so that I know exactly what the course directors are teaching and so that I can speak with a unified message when I get my opportunity to work with students. Also, my course directors work hard to develop learning objectives and it is my job to stick to those learning objectives. Further, my course directors work hard to develop rubrics for evaluating dental hand skills and it is incumbent upon me to rely on rubrics for a unified voice and a clear message to the students. And I always have to remember to put myself in my student’s shoes so that I can remain sympathetic to the things my students don’t know and the struggles my students face. Only after students have become comfortable with the the prescribed learning objectives can I then offer the new challenges of advanced techniques that may be of benefit but only after the basics have been experienced.

And how do I use learning objectives to guide students and help them gauge mastery? In my current role as a hand skill professor working under a course director and assigned to ten students at a time in the dental hand skills simulation laboratory, my options are limited. However, that doesn’t mean that I lack for good options. The best strategy at my disposal is to daily focus students’ attention on key aspects of the daily assignment (Ambrose, 2010,p. 114). I have to keep my ten students on task and I have to keep them focused on key components of that task. So I try to give them bullet points before they start their simulated patient treatment. As I know what they have learned in each of their dental hand skill classes my bullet points (or explicit instructions) help students to focus on what’s needed to get the job done and helps students to remember where they’ve been in order to bring old learning to bear on the current task. For instance, recently in one of the courses I help teach we were working on a particular task that required the students to use skills from a class they had over a year ago. By explicitly reminding students of: specific bullets from the current class; then asking students to remember bullets from a previous class; then me actually demonstrating what I was requiring of their work; then me explaining WHY we were doing things a certain way, I was MOST pleased by the results of their work (and I let them know that on the spot).

And how do I give feedback? As a hand skill professor working under a course director in the simulation lab I am limited in the ways I can give feedback. So my feedback has to be quick, direct, succinct, on-the-spot, and face-to-face. This type of face-to-face can be fraught with downsides so I have to manage myself well so as to only work toward a good end. For me I rely on balancing strengths with weaknesses when giving feedback (Ambrose, 2010, p. 149). I personally like praise so I strive to begin all feedback with praising those things that went well and/or improved from a previous attempt. I believe this keeps the students motivated and allows for an open environment where we can truly share ideas and learn from the experience. Then I get into talking about things that didn’t go as planned. It’s never easy to receive criticism (I usually hate it) so I am always very careful to not be attacking and/or provoking. In other words, I strive to have criticism be a part of the best learning environment as there are so many things we can learn from things that don’t go so well.

And after giving feedback I always ensure that the student understood what I was saying. So I always have a conversation with the student about my comments. I may give a demonstration. I may even have the student demonstrate the skill. This way I know the student has the idea of the goal in mind. Mastery shouldn’t be expected but seeing improvement in a particular procedure from a particular student the next time I work with that student (later that day or even later that semester) is proof that the criticism was warranted and pertinent. I will go out of my way to talk with students to see how a particular piece of advice has served them. And I always love it when students take criticism, make it their own, learn from it, and excel as a result. Students excelling at dentistry and developing mastery…isn’t that what we are (or should be) all about?

Ambrose, Susan A. (Ed(s).). (2010). How learning works: seven research-based principles for smart teaching. San Francisco, CA: Jossey-Bass

Umm, yeah, so where in the heck do we start prepping a bridge?  I’m sure there are a plethora of opinions (and probably even some evidence based research crap that someone had to do to get a Master’s or Doctoral degree).  Me?  I always seem to gravitate toward the lazy ass way of doing things (someone once suggested I work smarter and not harder…yeah right…).  So let’s get right to it (BTW, this write-up will pertain to a posterior bridge prep).

1. I prep the occlusals of all abutments.

2. I prep the functional cusp bevels of all abutments (and I am hoping that the angulations of my functional cusp bevels end up being somewhat the same on each abutment but is always dependent on individual patient conditions).

3. I will prep the buccal axial walls of all abutments.  By prepping all buccals at the same time I can make all of my buccal axial walls have the same amount of reduction/taper.  BTW, the buccals are, for me, easy (relatively speaking) to access and kind of become the cornerstone for my entire path of draw/insertion.

4. I will prep the lingual axial walls of all abutments and I will use the angulation of my buccal axial walls to give me the proper angulation of my lingual axial walls.  I always like to picture equal but opposite angles…3 degrees of taper on the buccal means a negative 3 degrees of taper on the lingual for a total taper of 6 degrees (my taper usually ends up being 10 to 12 degrees of total taper…5 to 6 degrees on the buccal and negative 5 to 6 degrees on the lingual…and that is well within “acceptable” to pass a practical exam AND Boards…Lord I hope to NEVER take another Board exam…XANAX PLEASE!!!).  And by prepping all of my lingual axials at the same time I can ensure that all of those lingual axial walls have matching reduction/taper (and play well with my buccal axial walls…I should see a good path of draw/insertion between all buccal axials and lingual axials at this point).  BTW, one of my previous blog postings (Cusp Tips on Crown Preps) has some suggestions for prepping axial walls in a way to get optimal reduction and a great path of draw with just depth cut measurements (lazy ass).

5. I will prep the distal axial wall of the mesial abutment and the mesial axial wall of the distal abutment (assuming there are only two abutments).  Why prep those surfaces now?  Cuz they’re easy to get to cuz a tooth is missing in between them therefore I don’t have to fight to do ideal preps on those axial walls (lazy ass).  And now by accessing/prepping all of the easy-to-get-to (relatively speaking) axial walls I can actually use all of those walls to nail down a path of draw before I tackle the hard-to-get-to in-between-the-teeth axial walls (it doesn’t always work out that I can get a path of draw early on but when I do it takes so much pressure off of establishing a path of draw on the mesial axial wall of the mesial abutment and the distal axial wall of the distal abutment).

6. I will prep the mesial axial wall of the mesial abutment and the distal axial wall of the distal abutment.  I will initiate my preps with an ideal MO box prep on the mesial abutment and an ideal DO box prep on the distal abutment using a 245 bur (I can drop Class II box preps in my sleep…please see a previous blog posting about how I do interproximal preps on crowns).  After creating ideal Class II box preps then I can quickly/easily (relatively speaking) blow through those cleared out proximals with my crown prep bur.  Finally, I will make fine adjustments to those axial walls to incorporate them into the path of draw/insertion I’ve already established with the easy-to-get-to (relatively speaking) axial walls.

7. I will finish things up with establishing my nonfunctional cusp bevel and tapering/connecting my functional and nonfunctional cusp bevels into the central groove mid-mesial and mid-distal at the occlusal/axial line angle. 

And with that, may we all find that path of draw/insertion that we all deserve and will lead to treatment success. Namaste’

So what in the heck do we do with cusp tips on crown preps? Are we “just” prepping them and hoping for the best? Or are we trying to accomplish something? And if we are trying to accomplish something what the heck are we trying to accomplish? In a nutshell cusp tips need to end up exactly where they used to be (and, of course, they’ll be a bit shorter: 2mm for porcelain fused to metal/all ceramic and 1.5mm for full cast) so that we can achieve perfect clearance for long term success of our crowns (including esthetics). And how do we put the cusp tips back where they used to be? I’m glad you asked (well, maybe you didn’t ask…and maybe you don’t care…which seems odd if you’re still reading this posting). We “move” the cusp tips into place through our prepping functional and nonfunctional cusp bevels. Huh? Yes! Those bevels are not just something we have to do just because we were told to do it back in our dental school crown and bridge class days. Functional and nonfunctional cusp bevels serve a…function (no pun intended…actually, yes, pun intended).

So how do we get those functional and nonfunctional cusp bevels to “function” properly. What sequence of steps do we follow? I like to start things off by prepping the occlusals of my crown preps first. Why? Is it just because I was told to do it that way back in dental school in my crown and bridge class? Yes and no. Yes, because I was taught to do it that way in my crown and bridge class (at the lovely University of…yeah, you all know where I went to dental school). And no, because there is more insulating tooth structure between bur and pulp on the occlusal versus the axial surfaces of the tooth…the more occlusal tooth structure I can eliminate upfront means less axial height/tooth structure I have to cut away which usually means a little less insult to the pulp (please don’t insult the pulp as pulps are very sensitive to insults which will likely lead to patient annoyance which may end up in your patient insulting you).

And how do we get the perfect amount of occlusal reduction? There are a number of ways we can bulls-eye our occlusal reduction. In the Simulation Lab we can and should use a putty matrix (preferred method as it gives an exact/objective measurement AND is how preps will be graded during the Capstone exam AND BOARDS). On a human we need to adjust the amount of occlusal reduction based upon clearance between our prep and the opposing tooth before we prep. It’s important to remember that on a HUMAN the amount of clearance between the occlusal part of the prep and the opposing tooth IS key. Remembering that we need 2mm clearance for PFM/ACC and 1.5mm clearance for FCC we remove only enough tooth structure to achieve that ideal clearance (for instance, if we have, say, 1 mm of clearance between opposing teeth before we prep anything then we only need to reduce 0.5mm to 1.0mm on our crown prep depending on the type of crown we’re doing). And there are various tools at our disposal to measure the clearance between our prep and the opposing tooth: wax (my method of choice); occlusal reduction gauges; ball burnisher; etc. In the Simulation Lab we are keeping things SIMPLER (if you can believe that) by disregarding the occlusal clearance between the unprepared teeth before we prep (we are actually assuming that our unprepared tooth is in exact occlusion with its opposing partner) and use STRICTLY the objective preparation measurements given to us by the putty matrix. And when we are done with our occlusal reduction we should have some semblance of occlusal anatomy remaining (same shapes just shorter) AND our inner cusp slopes of our prep SHOULD BE PARALLEL to the cusp slopes of the opposing tooth (that way there will be the exact amount of clearance throughout the entirety of the occlusal part of our prep). Further, our prep will NOT have any cusp tips at this point and our occlusal should look like Pac Man with its mouth open way too wide.

Now we have an important decision to make: do we prep our functional/nonfunctional cusp bevels first or do we prep our axial walls instead? If we decide to prep our functional/nonfunctional cusp bevels first it will give us less axial tooth structure to prep which might help the pulp a bit BUT it might be easier to overtaper the prep when it comes time to prep the axial walls. If we decide to prep our axial walls first we might be able to bulls-eye the taper on the nonfunctional cusp but not necessarily on the functional cusp (because it’s SO curvy) and we might insult the pulp a bit more. So how about a compromise? How about prepping the functional cusp bevel before axial reduction and then prepping the nonfunctional cusp bevel after axial reduction?

So let’s try prepping that functional cusp bevel before we do any axial reduction. And how do we prep that functional cusp bevel? Bur angle is KEY. And how do we get that angle? Line up your bur with the occlusal third of the functional cusps on neighboring teeth AND/OR the opposing cusp slope on the tooth opposing our prep (our functional cusp bevel will end up being parallel to the opposing cusp slope just like we did with the inner slopes of the occlusal part of our prep). Bur angle will be anywhere between 25 and 45 degrees and it HAS TO MATCH the angle of neighboring and opposing tooth structure (because exact clearance is key to crown success). And now with exact bur angulation we start digging first into the occlusal and then the middle third of the outer slope of that functional cusp. By doing so we create a whole new outer slope plane on that functional cusp that matches the angulation of the teeth next door AND ESPECIALLY the OPPOSING CUSP SLOPE. And as you’re creating that plane you will begin to see CUSP TIPS reappear. And as those cusp tips reappear we “move” them closer and closer to where they used to be. And when do we stop prepping that functional cusp bevel? At that exact moment when our cusp tips end up directly in line with neighboring cusps (or when the cusp tips are directly under their original position in the putty matrix). So now we should have three prepped planes: one inner cusp slope (buccal side of the occlusal); a second inner cusp slope (lingual side of the occlusal); and a functional cusp bevel (within the occlusal and middle third of the outer slope of the functional cusp). Those three planes should all be exactly parallel to their opposing cusp slopes (it will look like a capital N that is stretched/elongated with obtuse angles rather than ninety degree angles). There should now be a significant/prominent line angle where the functional cusp bevel prep meets the unprepared axial surface. Further, I haven’t taken the functional cusp bevel interproximally/gone past the MB, DB, ML, or DL line angles into the mesial and distal (I will connect/taper the functional cusp bevel into the central groove on the mesial and distal AFTER I have prepped the mesial and distal axial walls). And oh, lest I forget, the central groove will also be exactly where it was before prepping (just shorter).

Now what? Let’s prep our buccal and lingual axial walls. So now we need to be very cognizant of getting the right amount of reduction moving from gingival third toward the occlusal to give us JUST the right amount of taper to: have excellent retention AND NOT produce an undercut; avoid over prepping/over tapering. In doing so we really have to avoid having the axial reduction result in the loss of the functional cusp bevel that we worked so hard to make (in other words we have to make sure that our axial prep doesn’t go directly from gingiva to the cusp tips we worked so hard to produce/move into place by creating that functional cusp bevel…ya gotta keep a functional cusp bevel or ya gonna be over prepped/over tapered). So we always try to keep a bit of a line angle/break where the axial part of the prep meets the functional cusp bevel. And how do we do this? How do we get an outstanding overall axial reduction? We have to limit the amount of axial reduction occlusally to no more than 0.75mm greater depth than where we started out gingivally. In other words, a 1mm gingival chamfer will end up tapering to a depth of (ideally) around 1.5mm of reduction at the occlusal most part of our axial preparation. Or, a 0.5mm gingival chamfer will end up tapering to a depth of (ideally) around 1.0mm of reduction at the occlusal most part of our axial preparation. That’s not much (we can always make further adjustments as needed later on based upon individual/unique patient needs). And how does the proper amount of axial reduction look occlusally in relation to our functional cusp bevel and nonfunctional cusps (remembering that we haven’t placed a nonfunctional cusp bevel yet). Depth cuts from gingival to functional cusp bevel LINE ANGLE will result in a depth cut that is 0.5mm deeper than the gingival axial depth (so if we start at, say, 1mm depth axially at the gingiva then we should have a depth cut of around 1.5mm deep at the functional cusp bevel line angle). AND, depth cuts from gingival to the terminus of the nonfunctional cusp at the occlusal surface preparation (in other words, the LINE ANGLE where the occlusal prep meets the unprepared outer slope of the nonfunctional cusp) will also result in a depth cut that is 0.5mm deeper than the gingival axial depth (so if we start at, say, 1mm depth axially at the gingiva then we should have a depth cut of around 1.5mm deep at the occlusal/nonfunctional cusp line angle). And now we connect all of our depth cuts AND prep our mesial and distal axial surfaces (I describe my technique for prepping mesials and distals in a previous posting).

And now for the nonfunctional cusp bevel. Looking at the angle of the occlusal-most 2mm of the outer slopes of neighboring teeth’s nonfunctional cusps (which can be anywhere from 65 to 85 degrees) I can then use that angle and prep into the outer slope of the nonfunctional cusp/s on the tooth I’m prepping and “move” the cusp tips in line with the cusp tips on neighboring teeth (or prep until the cusp tips line up with where they used to be in the putty matrix). The process is very similar to what we did with the functional cusp bevel with the exception that there is no cusp slope opposing that outer slope of our nonfunctional cusps. Also, the nonfunctional cusp bevel on mandibular molars will be minimal due to those cusps having little to no contour. Further, I may have to “move” those nonfunctional cusp tips just a bit more than their original position if I find that there isn’t enough space on the occlusal most 1 to 1.5mm of the outer slope of that bevel to completely accommodate the space needed for proper crown thickness (1.5mm for FCC and 2.0mm for PFM/ACC) and this is usually readily/measurably apparent using a putty matrix (in the Sim). So now we should have a proper nonfunctional cusp bevel which should have proper clearance for metal or metal/ceramic or ceramic. And finally I will bring the functional and nonfunctional cusp bevels around the MB, DB, ML, and DL line angles and taper/connect them to the central groove on the mesial and distal.

Throughout my life I believe that, to a great extent, my educational and learning motivations have waxed and waned as a direct result of my goals. In my younger years, especially in high school, my goal was to get good grades (whatever the class) so that I could be accepted into a good college. And when I say “whatever the class” I mean I had to slog through a whole lot of classes that I really did not care for yet I had to do well in because my goal was to get the reward at the end: good grades followed by a good college. However, in high school I came to realize that I really liked my biology classes and as a result I felt more motivated to study and truly learn the material. Yet I really truly wanted to be in music classes above all else and I worked darn hard at music because I loved it.

Same story in college. So many classes I wouldn’t ordinarily think of taking but had to. Classes such as organic chemistry, physics, freshman english, etc. I had to take them either to graduate and/or qualify for grad school. Once again, I really wanted to take music classes because I loved music. For instance, although it was damn hard I really put my all into music theory as it pertained to one of my real loves which was (and still is) music. I so loved all of my music classes and music ensembles. However, I also really loved my January interim class that was spent in Jamaica studying marine biology. So I survived the stuff I disliked just to get good grades and provide evidence that I took the requisite classes. Yet I deeply enjoyed studying things I loved.

As an adult (OTHER THAN dental school) I have had much more control over the things I love and want to study. For instance, before entering into my Master’s Degree program (Dispute Resolution) I had a deep and vested interest in the subject matter. And because of that deep and vested interest I savored each class I took. Was it hard work? Yes. But I was so very motivated to learn.

So what does this all mean in relation to goals? Ambrose (2010) pages 71 through 72 helped me to see different types of goals I have employed (unknowingly) throughout my life. So back in those days when I was slogging through classes that I just didn’t want to take, yet needed to take and get good grades, I was adhering to the idea of performance goals especially performance-approach goals. As such I was focusing “on attaining competence by meeting normative standards” (Ambrose, 2010, pp. 71-72). And in those times when I really loved the subject matter and wanted to learn I was adhering to the idea of learning goals and as such I was working to “gain competence and truly learn what an activity or task” (Ambrose, 2010, p. 71) could teach me.

So much of dental school necessarily revolves around performance goals and performance-approach goals (because of so many disparate classes and some classes that just..suck). And so a big failure I once upon a time had in teaching dentistry was my derailing student’s tenuous motivation by trying to demand perfection: I demanded that students produce perfect work. And I would go so far as to have students re-do work until it was perfect. I was such an idiot but this was all I knew as this was how I was taught how to do dentistry back when I was a damn dirty diseased dental student at the University of Minnesota. And I really do think that this caused students to lose motivation. Worse, students began to fear me as a grader/instructor. They just couldn’t live up to the perfect standard. Students became frustrated and would just take whatever grade they received or just avoid me altogether. And I don’t think they learned well because rather than working with and through mistakes in order to make things better I would just have them start over (or kill their grade) and so they never had the opportunity to learn from (and fix) their mistakes. I wanted students to land at perfection every time with no mistakes and this was and is not realistic because in dentistry we are always having to modify things that don’t go so well (big shout out thank you to my dental school for turning me into a monster).

Nowadays I am a recovering monster and I really like to give timely, constructive, and targeted feedback (Ambrose, 2010, pp. 87-88) so as to NOT derail motivation. I try to start by giving praise for things that go well. And for the things that don’t go so well I inform the students, I empower the students with how to fix the problem if it’s fixable, and I allow the students to live with imperfections especially if it means that fixing a bad situation allows for a good learning experience. And I think this approach seems to resonate well with students (I could be wrong) as I sometimes tend to have a long line of students following me around seeking my advice.

Ambrose, Susan A. (Ed(s).). (2010). How learning works: seven research-based principles for smart teaching. San Francisco, CA: Jossey-Bass

OK, a few weeks ago I might have said a thing or two about the new Disney Skyliner (ahem…Skybuckets). Yeah, those new people mover things at Disney World that look like ski lift gondolas. So I recently visited Disney World and decided to experience the Skybuckets for myself. So let’s revisit this Skybucket idea.

Visually the Skybuckets are not obtrusive. The gondolas ride high in the air so they are not within a normal horizontal line of site. The towers that suspend the gondolas are really no different than seeing large electrical wire towers. The placement of the Skybuckets route does not impede the esthetics of the resort hotels and/or the view from said hotels. The gondolas themselves are attractive and most are decorated with Disney characters/scenes. The arrival and departure stations are esthetically beautiful and match their surroundings. There are not hordes of people exiting the Skybuckets all at once, such as what occurs with a Disney monorail or ferry boat, because each of the gondolas arrive sequentially and can only hold ten people at most. And the whole ride mechanism is very quiet.

Inside a gondola the ride is very quiet and very smooth. There is 360 degrees of vision and there are great views from the gondola. Also, my gondolas were very clean. When I asked a Cast Member about there being no air conditioning in the gondolas the Cast Member mentioned something about a venturi effect within the gondolas when the windows are open (and that 80 degrees within a gondola feels better than 95 degrees ambient). Overall, my Skybucket ride was cool, smooth, quiet, comfortable, and enjoyable.

The Skybuckets really shine when we think about the environment. Disney needs to move people and, historically, the most heavily used intra-resort mode of transportation at Disney World is bus. Buses are omnipresent at Disney World. I am grateful for the buses but they are noisy and produce exhaust. All that exhaust only adds to our carbon dioxide issues (I am happy to report that Disney is now using renewable fuel in its buses). Disney recently built one of the biggest solar arrays in Florida and plans to add more solar. As the Skyliner is all electric Disney can run the Skyliner with a minimal if not neutral carbon footprint. And having a few empty gondolas is going to be much more environmentally friendly than running partially full buses. And the Skyliner recently surpassed a million passengers so we can all do the math on how much fuel would have been needed to move those numbers of people by bus.

So, maybe I was a little hasty/nasty in my judging the Skyliner. It still doesn’t go anywhere I’m going at Disney World. Small price to pay for something that is good for the environment and good for people living their Disney dreams.

Grades. We live and die by them throughout our academic journeys. And it starts right out of the gate during that tender time we call kindergarten. Yep, right then and there it happens: we’re labeled. By a combination of our peers and our teachers we’re either lumped into the smart kid group…or the other group…because of our grades. It’s really easy to be moved out of the smart kid group but it’s nearly impossible to ever move into the smart kid group. And once we are assigned to a group we all start to look at each other differently: “oh yeah, there go the smarty pants” and vice versa. Often the two groups find it hard to intermix and socialize together. The two groups usually remain segregated throughout their entire precollege journey right through to graduation from high school. And within the smart kid group we find competition.

And throughout our precollege years we are constantly reminded that grades are everything. Grades mean college. Better grades mean a better college. A better college means a better job. And a better job means a better income. And people with better incomes…well, you do the math. However, once in college some folks seem to finally relax just a little bit because they made it to college and they’re on their way to their career.

However, those who need college as a means to be accepted into graduate school, well, you probably already know the story. Better precollege grades mean a better college. Better college grades mean a better graduate program. Better graduate degrees mean a better income…and so on and so forth.

Dental students work damn forking hard to get into dental school. And making it into dental school is such an incredible accomplishment and reward for soooo many years of hard work and sacrifice. But right out of the gate starts the whole grade shit show again. People become segregated. People get labeled. People become competitive. People do silly things in the name of grades. And grades can lead folks down dark paths of horrible stress, anxiety, and depression (even to the point of suicide). Grades can and do make generations of emotionally scarred dentists. And to what end? Can there be a better way?

Dentistry and dental school can, in my opinion, do without segregation, labeling, and competition. I may be a bit of a socialist (yeah, more on that a different day) but we’re all training to do the very same things in order to serve the public. In other words, we are a profession: we’re not trying (or at least we shouldn’t be trying) to put our colleague down the street out of business. We are a profession: we are a group of professionals coming together with a common goal to serve (…and to try to earn an income). We are a profession: we should be somewhat united in our ambitions and beliefs when it comes to the ideals of the profession.

But, in my opinion, it doesn’t seem to run that way. Shouldn’t it be enough to be accepted into dental school and become a doctor working as a team with other doctors? Well, things get a bit murky. We have good folks who wish to specialize. Unfortunately those folks are judged by the very same thing that we’ve all been measured against since kindergarten: grades. Our system of grading forces those who wish to specialize to continue fighting for grades. And competition can be fierce. And competition can be polarizing. And competition can be segregating. And competition can make people act in ways…well, you do math.

I’m not a specialist so I want to make sure I’m not just doing a sour grapes thing here: I graduated with honors; I was going to be a pediatric specialist but withdrew my application right at match because of my having to attend to family needs. I even won the University of Minnesota Pediatric Dental Award…and I boycotted my awards ceremony. Why? I was disgusted by the competition fostered by my dental school (you know which one it is). I was disgusted by the lavish awards given to the grade getters in my class. I was disgusted by my dental school’s fostering a culture that promoted specialty over general dentistry. I was disgusted by HOW FORKING HARD my friends worked to just be able to graduate and they got NOTHING. It’s as if becoming a general dentist was a consolation prize.

Let me tell ya, our profession thrives because of general dentists. And being a general dentist ain’t a bad place to be (seen any recent US News & World Reports about forking good jobs to have?). And please don’t get me wrong: I’ve been around some great specialists and some great people who went on to become specialists. That said, the opposite is also true. And I think we need to remember that specialists work to SUPPORT general dentists. Specialists can not work unless given work by a general dentist (it’s called a referral). And the specialists that I have CHOSEN to work with have all been OUTSTANDING SUPPORT for my practice. That said, I have chosen to NOT work with some specialists who could or would not support my mission with MY patients. And it makes you wonder: what kind of people were those specialists before they were specialists? Did grades and competition play into anything related to the formative processes that led some specialists to their station in life? Specialists: doctors with magical dental super powers who can exercise those powers only in a supportive manner when called upon by a general dentist (it ain’t about the jerk with magical super powers cuz that docta ain’t gettin’ my bizness).

So, maybe there’s a better way. Maybe there’s a way that we can all play together nicely. Perhaps there’s a way that we can come together as a team for the greater good of society. Maybe there’s a way that we can support and reward hard work free from the debilitating, segregating, and down right nasty effects that arise from grades. Is it time to rid ourselves of grades? Is it time to recognize that it’s DAMN FORKING COOL TO BE A DENTIST AND WE DON’T NEED A FORKING GRADE TO SUPPORT THAT FEELING OF COOLNESS??? And remember: I HAVE NEVER HAD A PATIENT ASK ME ABOUT MY GRADES IN DENTAL SCHOOL!!!

DDS…’nuf said.

Dental students are, in my opinion, quite brilliant and have to be in order to survive the academic rigors of dental school. So much information and so many classes are thrown at students in rapid fashion and in a very short amount of time to help keep the financial burden (which is absolutely ridiculous) and the amount of time spent in school to a reasonable level. And with so much information in so little time I find that students tend to compartmentalize (“box”) information as a means of academic survival.

Often there are dental school courses with disparate information that have no connections to anything and contain nothing relatable. These classes tend to be the ones we slog through the most and sometimes have to rely on shear determination and plain old memorization in order to survive. On the other hand, there are several classes that stream together marvelously and build upon each other. For instance, the general dental sciences courses, which I help teach, are the very skills that students will use for the rest of their dental careers. We start very basic and then we add more and more elements that connect from one general dental sciences class to the next, from one semester to the next, and from one year to the next with the ultimate goal of graduating a practitioner that is empowered to safely, skillfully, and compassionately care for their fellow humans.

However, (in my opinion) disparate courses with no apparent connections to anything hijack student’s abilities to make necessary connections from one class to another and knowledge retention/connection and ultimately implementation becomes disrupted. So often students are forced to jam information into their minds, take a test, then push that information to the recesses of their minds in order to make room for more information. And switching gears between these different classes can be difficult especially when there may be extreme stress and a lack of proper sleep, nutrition, and physical fitness.

Disparate courses are a necessary part of the dental curriculum however those disparate courses can create some frustrations for we faculty. We faculty know exactly what’s been taught in each of our classes and we faculty expect that each student will be able to retain and use what’s been taught in each of our classes. And as we know that the students were physically present in each of our classes, frustration arises when we come to the realization that information given minutes earlier can not be recalled, accessed, and used properly by the students. In essence, we faculty can lose sight of the fact that students have way more going on than what meets the eye. Even though we faculty are ultra focused on the importance of that which we’re teaching at that moment students are having to prioritize twenty different items which are ALL high priorities to each faculty they’ve encountered within a 48 hour time span (hmm, which of my twenty #1 priorities is truly #1?). Ya think that might cause a little brain pain?

We faculty, as dentists, have to constantly be aware that we have dental information connections that differ from our students. We faculty have been exposed to dental information for a greater period of time compared to our students. And as practicing dentists we have necessarily been forced to creatively combine information from many sources in order to better accomplish tasks necessary to treat our patients. This naturally gives we faculty/dentists a much deeper and richer and more connected/integrated knowledge base. Unfortunately our students (out of sheer necessity for academic survival) look at each individual class they take as a “box” with information that goes into and stays in each individual box. As stated previously, I believe this to be necessary for academic survival. And, yes, we faculty were dental students once upon a time and have necessarily been through the exact same things our students currently experience.

So, there is hope for our students. And we faculty have to be cognizant of the struggles that we went through as students so that we can recognize and be sensitive to our student’s struggles with burdensome amounts of information that may be overwhelming their abilities to integrate, connect, and properly use knowledge. Therefore I feel that it’s important for me to explicitly connect information and concepts for my students. Daily my students may have extenuating circumstances that disrupt their ability to recall information much less connect it and/or use it properly in their simulated and real clinical experiences without deliberate prompting from me. Through daily huddles prior to simulated and real clinical experiences I can deliberately bring prior knowledge to the fore thereby helping students to recall concepts previously discussed. What’s more is I can then take that prior knowledge and connect it to the day’s new information thereby creating a richer and more creative experience for the students so that they have more tools at their disposal and a constant reminder that we are truly building knowledge upon knowledge. This way creative pathways can continually be created and strengthened between new information and old information.

I hope this posting was helpful. Please let me know whether or not you hated it. Maybe you might have even liked it? 😊

This is a bit of a tough blog entry for me but I somehow feel very compelled to write it. And I hope this entry doesn’t come across as self indulgent or self loathing or seeking pity, etc., etc., etc. I just wish to be brutally honest (especially with myself) and maybe, just maybe, some good, both for me and others, will come from my outpourings regarding this journey. So, please forgive me if this whole entry elicits a feeling of needing to projectile barf (you’ve been forewarned…stop reading right now, if you wish, before it’s too late!).

Going on two months ago a very horrible something was perpetrated against me. Many know what that horrible something was and I am not at liberty to discuss anything about that horrible something. But that horrible something triggered my suffering/struggling with uncontrollable, horrible, and debilitating panic attacks. With a combination of medications and, now, counseling I am beginning to gain some ground on my panic attacks. This is quite the journey, though, and time, patience, progress, set-backs, happiness, sadness, frustration, elation, discovery, etc., are all part of this journey (one does have to be brave in order to heal). And I am ever so grateful for the outpouring of support from my employer (I have been granted medical leave time for treatment), my colleagues, my students, my friends, my family, and my wife (Saint Kris).

So everyone has shit going on in their lives. I think that’s an unfortunate side effect of living. Sometimes that shit is shit we can live with fairly unscathed. Sometimes that shit can do weird shit to us. And sometimes I think we never realize some of the shit that’s going on in other people’s lives. For instance, a few people might say that I’m kind of an upbeat person every once in a while. Little do people know about the shit I have festering in the background. Huh? Many years ago I was inspired by two books: The Inner Game of Golf and The Inner Game of Music. Basically those books describe how we can deal with our shit and put our shit in the back of our minds so that we can get our shit together so as to perform at our very best. When I’m on stage (I use “stage” as a metaphor for life) I have to have my shit together and for the most part I think I do this fairly OK from time to time. But I’m learning that the horrible something that happened to me probably overwhelmed my coping systems. The horrible something was a trip wire that set off the bombs in my mind. And this is likely what led me into this journey with mental illness. And this same process happens to SOOOOO many people. And it is good and right to get help when this happens.

So what’s been going on in my life (bail out now if you haven’t done so already…here comes the self indulgent shit!)? Let’s go back a year in time (if you’re still reading you are brave!) and look at things in order.

Last year at this time my beautiful Jasmine kitty was still alive. She had significant kidney failure. Further, I needed to test her blood sugar twice daily and dose/administer insulin twice daily to help manage her diabetes (umm, yes, I had to prick her skin to get a blood sample and I had to inject the insulin). She was on a strict diet to keep her kidneys and diabetes in check so she had to be isolated from our other cat’s food. And daily I knew that Jasmine could have a really bad day that would necessitate my having to make a very difficult decision.

Last year at this time horrible body pain ultimately led to my having to become gluten free. Though I may seem upbeat about being gluten free this is sometimes a daily struggle. I have had to change SO many things in my life. And I have to be SO careful. Carefree eating is a thing of the past. Going out to eat on a whim can be daunting. Grocery shopping can be frightening/frustrating. And vacationing can be a downright nightmare when thinking about safe food options (thank God for Disney and their accommodations).

Last year at this time we were moving my wife into her new dental building. This was not without challenges. We were moving everything out of the old office. We were closing the entire practice for at least a week to move and get the new building up and running. We were worried about finances with the practice being closed for a time. We were worried about patients being able to make the transition to the new building. We had city inspection/occupancy issues that threatened to delay opening of the new building (it was silly stuff such as being short one 14 inch by 14 inch carpet tile that had to be ordered…what the fork?!). The bank bungled a bunch of loan paperwork right at closing. We had to cancel and reschedule the closing during the actual closing because we were missing x number of documents from the bank (it was, like, what the fork is this and what the fork are we signing?). We needed to close before December 31st and we were putting the final ink on the closing documents at 8PM on December 31st (Happy New Year).

A friend/colleague unexpectedly moved away.

Extensive and dangerous road construction have made for very long and stressful morning and evening commutes.

A very dear friend passed away. I held vigil at his bedside for days with his wife (also a dear friend) all while the polar vortex raged.

I grieved for my dear friend.

I helped my dear friend grieve/mourn the loss of her husband.

I helped my dear friend put her house and life together after the loss of her husband.

I helped in the planning and running of my dear friend’s life celebration (it was beautiful).

I have been helping my aging parents with their health struggles.

I went on a family vacation from Hell. For instance, due to traffic I almost missed the all aboard for my cruise out of Miami. There was a BIG family fight during the cruise. And the cruise line lost our luggage.

I had to say goodbye to my beautiful Jasmine kitty. To make matters worse, I had to make the decision to say goodbye to Jasmine while I was in the Miami airport waiting to fly home from the cruise from Hell (we boarded Jasmine during our vacation and while at the airport we got the call that her kidneys were in total failure). That was an awful flight home.

A musical group that I performed with since 1991 asked me and another one of my friends within said organization to fire (instruct to retire…but for all intents and purposes it was firing) one of my best friends/mentor who had been playing with said organization for MANY years. After very icky negotiations with said organization my friend and I decided that we would/should not be the people to fire our friend/mentor. Afterwards my friend/mentor was treated HORRIBLY by said organization which led to my decision to resign from said organization. Said organization was my mental rock through so many of my life’s changes and saying goodbye under said conditions was TOUGH and SUCKED!

Repeated asthma attacks led me to withdraw from running the Door County Half Marathon.

My Sulley kitty suffered a horrible bowel obstruction that required our administering multiple enemas (with subsequent HORRIBLE messes). Sulley was ultimately diagnosed with megacolon which means that his large intestine is ceasing to function. Twice daily Sulley receives three different medications to keep his large intestine working and he is on a strict diet. Eventually the medications will cease to work and we will have to decide whether to spend $10,000 on surgery to completely remove his large intestine or say goodbye to Sulley.

My place of employment is perennially short of faculty and I work myself to exhaustion daily. I get quite anxious when I see multitudes of students needing help and I am powerless to do more.

I did some extensive committee work for my place of employment which was very mentally challenging.

Played my last concert with my friend/mentor. Per usual, we drove together to rehearsals. After our last rehearsal together I dropped my friend off at his house and, while driving home, had to pull over as I could not see the road through my tears. I balled all night. My musical life would NEVER EVER be the same again.

I accepted my appointment as a Faculty Liaison to the MUSOD D1 class. This meant extra pressure/nervousness.

I accepted my appointment as an examiner for MUSOD Patient Based Skills Exams. These exams are required for graduation. This meant extra pressure/nervousness.

One of the courses that I help teach received a new course director which upended my ability to comfortably teach that class (tough transition).

I was hit with the sickness from Hell that required two separate rounds of antibiotics and LOTS of albuterol. Sleeping was difficult at best.

Another musical organization that I performed with since 1990 was no longer going to be rehearsing at Carroll University (where I did my undergrad). I’ve been performing in Shattuck Hall at Carroll since 1989 and losing my performing at Carroll was yet another blow to my musical life.

My little Reggie kitty suffered a knee injury and couldn’t walk (he’s better now).

My wife caught my sickness from Hell.

The sickness from Hell resulted in our cancelling two little weekend getaways to Wisconsin’s Door County (very sad…I really needed that time away).

My Hercules kitty fell ill and was wasting away. He was finally diagnosed with inflammatory bowel disease. He is now on two medications daily (one of which is prednisone) and has a very strict diet. We are waiting to see if there is underlying intestinal lymphoma which may require extensive surgery. But at least he’s eating, putting on weight, and generally looking healthy again.

And then there was the horrible thing perpetrated against me.

So, we all got shit going on. Sometimes we can handle it. Sometimes we can’t handle it (and that’s OK). Sometimes things happen that tip the scales toward not being able to handle it (and that’s OK too). Sometimes our actions toward others can take someone’s precarious situation and turn things in a bad direction. Maybe we just need to remember to be nice to people. Or maybe we just need to be respectful toward others. We don’t know the burdens that people carry. And our actions can make or break someone’s day. Kind words and a smile are healing gestures (at the very least they’re comforting). Even our body language can make or break someone’s day.

It’s OK to have shit going on. And it’s OK if the shit overwhelms us. There are really good people out there who can help us when the shit gets too deep. Reach out for help. Life is worth living well and we all can work together to achieve a life lived well.

If you’re still reading this, thank you.

I want to be really careful about jumping on the whole Thanksgiving “I am grateful for…” bullshit bandwagon. Don’t get me wrong, Thanksgiving is one of my favorite Holidays. But one culture’s Holiday is another culture’s Hell: not all folks celebrate Thanksgiving. For instance, many of our Native American sisters and brothers are diametrically opposed to Thanksgiving (and that’s a discussion for another day). But I do want to talk about a love affair that I’m currently in (and it’s not my love affair with my wife). I’m talking about my ongoing love affair with…Lake Michigan (which means I am grateful for Lake Michigan).

My love for Lake Michigan goes way back to when I was a little boy. As a boy I would beg my Dad to drive me down to the Lake. I loved sitting on the shore staring out at that big water. I loved seeing sailboats go by with big billowing colorful sails. And holy crap bonus points if I happened to see a big ship go by!

As I grew older I was eventually able to drive myself down to the lake. I found hiking trails (such as the Seven Bridges trail in Grant Park). I found biking trails. I explored beautiful parks and outstanding nature centers (such as the Schlitz Audubon Center). And I especially loved getting up early to watch sunrises over the big water.

My family even vacationed on the big water. Several summer vacations happened in Wisconsin’s Door County where the big water dominated pretty much everything we did (and to this day I try to get back to Door County with my wife as much as I can…have trailer will travel..and I argue that Door County is every bit as beautiful as, say, Bar Harbor/Acadia National Park in Maine).

And as I’ve grown my thoughts about the big water and my relationship with the big water have changed. Perhaps at one time in my life I didn’t realize how very important the big water was to my life. Perhaps at one time in my life I may have taken the big water for granted. Perhaps at one point in my life I may have even forgotten that the big water was even there (a lot of bullshit on the brain can make you forget the important things in life…at least that happens in my life). Leaving the big water for many years made me realize how big a part of my life the big water represented. I missed the big water. I longed for the big water. When you live near the big water life stops and starts at the big water’s shore. You can’t go any further East than the big water and then you turn around and begin again in another direction. Living away from the big water meant that life stretched on in all directions with no discernible end point.

And now I come to realize that just about all the liquid in my body is Lake Michigan. Lake Michigan gives me life. And Lake Michigan gives life to everyone along its shore. Life along Lake Michigan exists because of Lake Michigan. Could Milwaukee and Chicago be what they are without the life giving waters of Lake Michigan? Could Milwaukee have become brew town without Lake Michigan? And the big water is there everyday giving of itself and not asking for anything in return. It’s doing nothing but at the same time it’s doing everything.

And I argue that Lake Michigan has been doing its thing for a VERY long time. I am a bit of a geology nut. As such I have to subscribe to Earth/geologic time vs. Biblical time. And for those who subscribe to geologic time I argue that Lake Michigan may be one of the OLDEST bodies of water on the planet. Granted, all of the salt water is gone and the shape/depth of the big water has changed. However, all of Eastern Wisconsin was an ancient tropical ocean. And I’m talking billions of years ago. WAY before dinosaurs. I’m talking primitive times. But the evidence exists. All of the limestone around Milwaukee (and even the limestone of the Niagara Escarpment in Door County) exists because this was the bottom of the ocean. Even in the parking lot at Milwaukee’s baseball stadium (Miller Park soon to be AmFam Park) stand limestone bluffs that contain fossilized coral! I think that’s so cool!

But as I look around I am saddened by how easily and quickly we can mess things up. Yes, I took Lake Michigan for granted once upon a time and I am ashamed. And I wish to point out a few things now that I have awoken from my sleep. Invasive plants and animals threaten to destroy our beautiful big water (Asian Carp are at Lake Michigan’s doorstep and Zebra/Quagga mussels continue to wreak havoc). Continued dumping of sewage and industrial/agricultural effluent continue to degrade water quality (well, as most of me is Lake Michigan I guess I may literally have shit for brains!). Foreign ships entering Lake Michigan continue to dump bilge water containing biological stuff that was never ever meant to be here (such as Zebra mussels). Native fish populations such as Perch and Lake Trout continue to teeter on the brink of total collapse. And political/economic pressures make it nearly impossible to achieve any level of ongoing conservation. Why the fork is it so hard to do anything good for the environment especially when it means life or death for our own wellbeing?! Pisses me off!!!

But there is hope. For instance, researchers in Green Bay have been planting native mussel species in the Bay and have been watching those native mussel populations rebound. What’s more is the native mussels are outcompeting Zebra and Quagga mussels. How forking cool is that? As a keystone species mussels are the life of the big water and their survival (coupled with our providing them what’s needed for survival) may mean new life for the big water and subsequently…us.

We can do this. We have the knowledge and the tools to do good. Doing good is always harder than…well, you do the math. But doing good is…good…and the right thing to do. And I look forward to continuing a…healthy…love affair with Lake Michigan.

Thank you Lake Michigan for always being there for us. You always give and always ask for so little. I hope I can give back a little.