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Being Willing to Fully Invest in All of Our Patients

Stephen Wright

Description

A presentation meant to:
1. Equip dentists in the treatment of patients with autism through behavior 
guidance and non-invasive procedures.

2. Motivate doctors to have the faith to incorporate an "eternal perspective" in their practice through personal mission stories from our family's time in Peru.

 

Objectives:

  1. Demonstrate new treatment modalities for patients with autism and how they can impact your practice

  2. Discuss ideal methods for evaluation of business success

  3. Illustrate how to incorporate sustainable, long-term missions and charitable giving into your practice 

Presenter

Stephen Wright

Pediatric Dental Resident at Nova Southeastern University

Conference

Recorded

  • October 27, 2017
    4:15 PM
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The title of our. Presentation being willing to fully invest in all of our patients and that title kind of came about. In trying to encapsulate and encourage all of us to redefine maybe how we determine success and to help us to see God's people for who they are and I know how it can be where we don't feel like we had a very. Productive day if we didn't have a very productive day if you know what I mean and and sometimes if we. Are looking through our practice through the lens that is the Bible and through God's eyes sometimes having an unproductive day on paper it can be a very very productive day in your heart. So I'm going to share with you first off just just my testimony and so and it's going to start where my dental career started which wasn't too long ago graduated dental school in two thousand and thirteen. And grew up as the son of a Preacher Man and had all the blessings of the advantage bringing great dad just. Help me to stay on the straight and narrow like I had to choose right and wrong but I was given a good foot up if you know what I mean and so one thing that if throughout my story even to this day. I struggle with complacency I don't know about you but sometimes I can see myself as being in a comfortable member of the advantage. And that my mission then tends to be one of social and and not so much of my purpose of winning souls for Jesus. So right after school didn't know where I wanted to go or exactly what I wanted to do. God called us to a small to. Down of Currawong. Peru and this is a picture of of curry Wasi it is in. The region of Peru which about two hours outside of Cusco if you could fly like a crow or a condo or and you could go over those mountains and behind the Capitana Rumi was that peak then past there was cell can tie in on the other side of that you and down a ways was much you beat you so if you could just fly. Might you be to be really close. But it was another two hours back to cruise go in a three hours to much of beaches that we were we weren't that close. We lived in the town called Kerr Wasi and this was our dental clinic there in the first. First floor of that building there when I first thought God was going to call me do some mission work I figured I'd be a great oral surgeon and I'd be pulling a lot of teeth because that's what I knew in dental missions as pulling teeth right Carlos Yeah I learned from the best this guy taught me how to Gnome and how to take out teeth and Honduras and. So. But I came across this place and. There was during school that I was just kind of in a in a study break us like if God could send me anywhere where would I want him to send me. Now is my selfish question so I'm there on Google Earth morning or I I love to go here though to go there I love big mountains and I've been to much of peach you once when I was having to scholars abroad on Argentina they took us to much beach and all those mountains were great. And so I there was a there was a town that was going around the national park of of much of peach you and it's very big and there's a small town called. Insist like my third year of dental school and I was like oh man if God can always send me there come senior year. I get a call from a guy you know up and kind of put some feelers out and there's an opportunity to go to a place called curry Wasi Peru as I go I looked at a place in Peru a year ago and so I checked out where it was and lo and behold those about twenty two kilometers away from the town I looked back could could sure and so I knew that that was kind of my Wynnie moment through air punches and then I was excited we went there it was a stay at the our dental clinic. Here is here is our dental clinic there we had electronic hand pieces we had and we had a digital machine in radiographs we had our own lab. In which Lisa was our lab technician from Germany with fabricate the crowns we had a Syriac machine it was first world dentistry for a third world population and it was in it and the kind of the the work they were doing there was very. It was very rewarding and I loved how it was done because while I strongly believe in free clinics. There's something about. Mission work sometimes not all the time when we don't have a constant present presence in an area and there becomes this kind of north american savior complex that you might have heard about where people come in they give you free things oh you poor little souls you can't take care of yourselves let us take care of you know this for you OK. And that wasn't the thing there they would they would pay for their their treatment but it was on a scale that was to them so they would ask them what is your house made out of and how many people are living in your house and you look at their clothes and it was a judgment call I'm sure it wasn't perfect and it might have cost in the comment of cost and you know a couple days of wages. But on our scale about ten bucks right so as it was it was a it was a cool system. We saw. Nine year old with a bombed out sixes and lots of occlusion. Got some good experience in and oh there it's a picture of my M.B. two that I found one day you can't really see very good so. So general dentistry is is what I did and. Then it was rewarding work it was a. Work that didn't pay. And that was part of the part of the difficulty in part of the reason why we came back because we came back with a little bit more. Debt than we left with but that wasn't the only reason. So here's just a few pictures of the dentistry that we were able to do. On a toot my own horn a little bit there and they had or and witchery into baited the kids and sometimes had to do some. You know full mouth re a rehab there and that little girl there and and some good impaction I didn't true my own. I didn't get all Lisa I think I have a picture of Lisa coming up here is Lisa she was my my main my main I want to say main mansion I'm a woman she'd come in there and help me you know check the check everything we get the color right together in and when we did some great dentistry and it was. That was that was our denture that we delivered from the. Lisa she's trained in from from Germany. She is not but there is another lab technician there that also from Germany and and we have dentist from Switzerland and so there and so they seem to come in like when I first went I wanted to go for a year and then the director the programs like No we don't want that kind of turnover because if you're there year sees you start getting like you're you've got everything down you're already thinking about your family and what you're going to do when you get home. So so. Really I went thinking that two years was long term and I came back realizing it's short term it's really short term. Because time flies and seems like two years is the magic time when you start making connections so it was really kind of a pity this next slide we. This is Erin she's also still there she only works there one day a week but she works in a town called out. And she's a dentist trained in Washington state and they've been there for coming up on like ten years his her her husband. Spoke fluent Spanish so he put his mind to learning catch work which is the native language of Peru and. And so now he was she does a dentistry. He's teaching the locals Bible stories. And teaching them to read via the Bible stories and so it's a great great way to incorporate. Both physical healing. And in the spiritual healing that so many people need they've been met with torches by by members of the Catholic Church say we want your to out of our town last time you hear some of our cattle died we don't want you back here again and so they've met with some resistance but that's the cool thing about stick. In around your true colors come out and they've been doing some great great great things so dentistry as you all know is an awesome profession but can get boring right so I think hobby is a great way to reach other people for the Lord and I love and I love to run and so I incorporate my love to run with with these little kids in our community and that's my son John Paul there. We adopted him when he was about eight years old and he. Did so great and he still misses it because he had walked out the front door and he had immediately ten friends just to play with and so we started a running club. Running Club that would meet three days a week and we'd run the same two or three routes and then after you know about every couple months we'd have a race. And it was it was a cool thing to see and I think we can do is apply the same concept to dentistry to see those kids say Hey if we do and we can't run this far kid run that you know like five we did like three miles and we can run the four and then they do it and you got all my a good job that was awesome and and they were like yeah yeah yeah and then they do it again they do it again after they ran five times they got a little punch or they got a car with their name on it and so then they got twenty five punches in their car they got shirt. And at the end they just loved running because they could look back and say you know this where I started and now they're running it fast I can run the whole time enough to walk at all and that's one thing that I think we can incorporate into the field of dentistry with our kids I think a lot of times we feel like if we didn't do the filling meaning get something done we didn't walk out a code that we weren't successful at that day and so we're going talk a little bit about autistic patients and patients that nobody truly enjoys seeing. And how we can kind of rewire our brains a little bit to to help see the success in that and we have to kind of adjust our our expectations of how the visit is going to go. This is easy to low and Jorge some of my boys. Just looking at these guys talking about it I get emotional. They're there they're out there. And sometimes you know we we still feel like we belong back there and that the end of this presentation I have a play and I have a plan of how I might get get back there. And you know it's a point you know the Lord changes things and he. Often often. Surprises in there. Yeah I'm going to share with you and and. And hopefully encourage you and your point. This was after our first race and we took a picture of the family members that came out encourage our young ones in and it was a good time my dad happened to be there and it was awesome. So February is water five months and after every once in a while we'd have some parties where we'd celebrate someone's birthday or this is this is church in our houses now having a church in the town which was a struggle and a blessing. Yeah so. Came from from when I when I came home to do some fund raising This is what I'm doing and would you help us out because we we ran out of money a little bit and. But so those were counted all the glamour shots it wasn't all great we'd be with weeks without water. My my wife was diagnosed with Graves disease were there which isn't a life threatening deal but it was a big issue for our family. So we didn't nose and has a dentist you know we're taught to chair can and to read signs and symptoms and it went right over my head I didn't see it and then after I saw you know how she's been you know how she heard her body temperature. Can And she does have. And. Why didn't I see this before and the first several months she was like. No eighty nine year old woman that we're on a hill like this I told you we could see seventy seventeen thousand feet for those in fees is very trying time. But it was rewarding it was awesome it was great and the Lord saws through and. So that is that was our time time in Peru does anybody have any questions about about. Our time in Peru or or any like you know how did you do that or or any ideas you might have or questions you might have in regards to that. Well. We had three dentists and so it was down to two for a little bit. And then they got another dentist from Germany so we had a Peruvian dentist Erin was the american dentist and we had a dentist from Switzerland. And you. No nobody at the hospital supported at all from the the. Hospital. They'd pay and that would go to sustain the building and pay the locals the local nurses and things for that. Yeah yeah yeah good ole people back home. Kind of kind of foot our bill was about in is actually more money than I thought it was going to be because you think like you know it's like three to one ratio for the dollar over there so I thought our money would go really far and I mean into a house and we're livin in the hospital for a while but that wasn't gonna work for very long we finally found a house in it in every fridge and have a new furniture and in any beds. So we had to buy a lot of stuff and it cost a bit more I think I think each year is about forty thousand dollars that we used going back and forth with some cost to get involved in with. Me and John Paul had to leave Peru to renew it one time and I was safe in the had to go home when she was diagnosed with that and she spent some time here in and yeah so you know. That's how we sustain ourselves I wish she was administering a clinic i wish but it definitely all the patients were seen in the morning and we had a chapel service in which we worship in the past would preach the word Sometimes I didn't agree with the word mind talk about hell or and hellfire and whatever else you like. But that's. But the ministry was definitely there I mean the people there were on fire for the Lord and so prayer with patients was calm and the music in the waiting room and. Just the long term presence of the people that were there because we didn't live in like a compound hospital compound we lived in the community our neighbors were our became our friends you know we didn't really secluded ourselves on Friday nights we would get together and have a worship service with other missionary families. But our daily friends and neighbors were. Locals that we would invite over to our house to eat. I mean that's I mean if I was about dentistry but invite people over to your house to eat you know. Being for years in Memphis for dental school and thinking people were going to invite me over from the church and then get right over we have venture near the end of time invites people clicked like manna next time a new town I never buy over to my house to eat you know because when you when you when you're across a table or some things things just click during your space this is my home this is my life and I care about you let's create a relationship we can talk more about this. I'm going to get on to the pediatric dentist or part how many of you guys like to see kiddo's Yeah. Yeah so we're going to talk about kiddos in what's new in pediatric dash I wish I had all these this. The are new things that made kids just love ya to magically But but I don't. You know Harrison is my youngest one he's five months now and he's he's a step in and he's being original so I can this is toes and. We're going to talk about some restorations and alternative treatment and some behavior guidance and I hope to get a kick a large part of my behavior guidance is like no interest oxides so. It is what it is. So. This is basically me a thinking how can I help. My my brother my sister in Christ be awesome or a pediatric dentist is the best I got if you guys already have this mastered I'm sorry but this is just what I thought you know just rock it how can I help these people be better at treating kids and so we're going to talk about entier strip crowns. Pol Pot I mean I've active I took that slide out Actually I'll just mention now since there's no slide on it it was just is just material you could should treat it like a composite she treated like a flow book composite and in pediatric dentist are using it more and more and more and more for the patients they need to get done quick sometimes I think they use it too much if you look up active has great great great things to say they're really good advertising the product. But there really isn't that much research behind it to make it like this is what we need to use I still kind of do an India or an M.O. it's packable composite you know but this is this finishes well it's muz up well it's supposedly supposed to bond hydroxy appetite in the bombing in the tooth in the material supposed to get stronger in time instead of weaker. That's that's the word on the street OK but there's now a lot of research that the talks about. Silvered I mean for I'd. Anybody you guys use that yeah so maybe that I'll talk a little bit about that to share for you I wish I had that in true man I wish I had them proof because that is a great great. Thing that we can offer for our patients Tobiason time it's not like the end by any means. And it's not as good as they originally thought it was it's like working eighty percent of the time you need to have occasions will get to that in the slab. And direct indirect ball caps and and the like so isn't that a beautiful prep and yeah that's my ugly prep and that's just on a type of model. But this one has been done in this one is imminent. I hate doing you know inner proximal right here on a four year old three year old they just don't last and it's hard in there that little. And this holds up a whole lot better if the lesion is is tiny tiny tiny Yeah composites fine but this is going to last you a whole lot on and you don't need to spend a lot of time so it's this trip crown you're going to put a hole in the back of this surface here you know about two millimeters big might pop a hole in the top here in here and you'll fill it with a pack of a composite and after you've prepped the beautiful prep you'll put that thing on there in you want to check it first because you want to be a little subjective also it looks it looks nice and then you finish it up doesn't have to look awesome that's a first tooth one of the first to come out strip crowns N.T.A. Pol Pot nice. So. Former Korea saw you know your former Korea saw a fair Excel fête Pol Pot a mes. And now I think the trend is coming to N.T.A. and so with M.T.A. You know when you do a pop out of me you valuate the bleeding. If it's if it's just profusely bleeding we know things probably not going to be going to last and probably just needs to come out now there's people that are doing a new treatment which they put in a biopic at the bottom at the bottom and they've shown some success with that but that's kind of like a cowboy. Thing there too and sure if that's going to hold up I'm never done that on my own. So for the technique of this is you just apply pressure with Cora hex again and if it's still a little bit go down a little bit farther in the can now OK And once the bleeding is stopped and you dry that out and you place your hand T.A.A. and then you then you fill it you know like you normally would and with your huge you know and and your and your. Yes yes. That's. So a lot of times that's kind of like that's almost going a little bit above and beyond what a lot of people do so are you controlling the bleeding. Beforehand with form across all or diskette. You know so that's what a lot of that's what the office that I work here in view for did we did a fair fair Excel fate and. So there's a little bit more of a failure rate with that and you see a lot of internal resorts but I think there's a technique that is involved in it too because I think if you use a lot of disco stat and you leave a lot of disco stat in there. It's more likely for it to. Not have a great outcome internal resort and if there's interest does mean you have to take out the tooth if it's a sin to Magnes interest or action and they're going to lose it in a couple years anyways I would I would argue that you should just watch that anyways question. No you're zinc oxide you usual whatever material her brain uses going to be the bulk of it I'm talking about just just the just the floor just the bottom and. Yeah I hear most people are using Neo N.T.A. because a little bit cheaper and then they'll they'll break open the pack and they can use it one thing of it for multiple patients or multiple Pol Pot means they're mixing it and they're using it another another cost saver is if you mix it with like a cane. You know because you already you probably don't use the whole Carpio and you can use a couple drops of that mix it up and go from there. So that that's where it's heading now there are a lot of programs including my own that I am currently a resident at that we're still in former Korea saw. It's coming down just like they're cow they could I'm not sure they could. So. They're just like in all dentistry there's like one hundred ways to skin a cat right but the research tends to be showing and if ever you have a question like OK what is the what is what is was a research saying what is you should go to a P.D. dot org because that's what pediatric dentist are going to quote all day long and if you want to talk educate lein if you want to back up why you're doing something you can see you go to the policy and guidelines or I think they just change the name of it but you go and they click on then and they'll tell you no this is our stance and so over timing for it is our stance on fluoride is our stance on all these subjects that's just a go to resource and when you're talking to anybody. A P.D. American Academy of Pediatrics industry dot org. Yes indeed so direct and indirect all caps so. This. Is no different from from from your from your permanent permanent teeth and you'll find a lot of different. Opinions on what to do whether you should place your couch in my garage and if it's necessary I have been tend to be. To have more of the thought of if there is a. If we have. An exposure and it's not bleeding. M.T.A. and then go from there also casting hydroxide that's another great one and then and then you restore it if you feel like there's nobody and you got that on then you put your glasses on were based on top of on top of that and then you edge and you do your normal restoration. Some people if there's not an exposure they feel like there's going to be still some kind of micro communication with the pulp and they still use the calcium hydroxide. But I tend if I if I if my Explorer doesn't go into the pulp I don't mess with the calcium hydroxide just put my. Glass on him or base down and go on from there yes indeed and. One thing I'm. I'm a general dentist went into pediatric dentistry and I can attest to the fact that this is true I don't like stainless steel crowns I didn't like them when when I first was forced to start doing it I'd rather do you do Deo in a Nemo in so I think sometimes week in I want to talk about this because sometimes like that tooth for example you see in the top left that should be a D O That should definitely be stained so crowns most likely going to be a pulp and Crown. Just because I've seen so many and where they go. So a lot of reason is because this the fail rates really bad you have decreased bond strength within a mole and and dead in on a primary teeth and. And. So well let's look at some of these these X. rays. So for an approximate. Yeah. So I think the in our practice it was that activity was kind of taking the place of that for us. But it's kind of the same deal. And we. That's kind of here carries management if you have a lot of decay and it's going out of control and you want to discuss stop things from me going any farther you can. Use glass on a robot not. To be honest with you you know it's going to be you a composite for the most part and. The stainless steel crowns us like the bread and butter of your dentistry. Sometimes So when we're talking about this we have to talk about the age of the patient the amount of Kerry's present education of the parents their involvement their finances and all those types of things. You can have you know if you have a ten year old in there have a couple more years of that too thin there you talk about one of the one of the first or second baby maulers. Be all right mom's going to freak out about it she doesn't want that silver in there no way I'm not doing that then then I'd be OK with doing a composite. If the kids you know four years old I'm going to have to really talk to mom and try to say hey. You're going to be wasting your money with this because you're going and you can be back here again in a few years and and we're going to do this all over. So age amount of cavities like so if you saw this guy and there was only cavity. Well and let's say they're seven. I might do a deal on that you know. But because I know and maybe like there you can tell that they're there with you they're going to take care of than a foster kids teeth and they're gay. To make sure that he has any sweets all the time but if they're a little bit. On the side of like you know you can tell that they're not I don't care about the teeth whatsoever. Then we need to we need to protect that teeth a little more aggressively and mess around with put in a composite and they go if things don't go. So silver dime in for a ride. It's been used in Japan for many many many years in other countries as well and it is what the name says it is a silver diamond for a ride and it's made up of thirty eight percent seventy four odd it has a Ph of ten and that's the four I content there are four hundred thousand parts per million four rides colorless now they're making a. Blue liquid that is a little bit helpful in scene scene where it is. On the tooth and if you use super floss if you're trying to do something in a proximal haven't done too much in there but you'll see people put it on super floss to help re mineralize an area between the teeth. They say if it's getting close to the pulp it's probably not a great idea if you're over two thirds of the way through the day and it's not going to probably do the trick but if you can catch it in the first third of the day and it's amazing how it will buy you so much time. So the technique is just to keep that tooth isolated the little kid will say you do and. Plays video and I'm just showing you what has already been done and they'll tell you a little bit about it. So we don't have any sound on this but sing in the A.B.C.'s to this little in this little. Kiddo here and you can see it's kind of some discoloration here so they have in this case they do have a glass on or in this would be one of those that a glass on a movie great to go on top of this so you would treat and it's amazing how the bond strength of the tooth this black tooth is still. Good you know you so you'd treat it like a normal US Army have a normal primer that comes with a glass on and you do that and you put the glass animal on it and that's just to kind of cover up aesthetically you know the parents don't like the black So we see in the back but we don't see as much in the front. You know. You can a little bit with the rounder you know just just and especially if they're on one trysts and just kind of take the majority of that because you first just go in there with the severed I mean for and then you just leave it on there for two minutes with your brush. My professor says don't take the micro brush off of the tooth leave it there for me I've I've kind of my technique identical teeth and I just kind of keep pressing on and it depends on the behavior of the child because this is an ideal treatment right so obviously there's a behavior management situation or they're too young or trying to buy some time but it really does buy you some time because three years old the difference between three year old and a six year old can be huge you know and if it's a back tooth. There's there's a you know the parents know I call it up from but if they don't see it and if they're in if it's the option of OK we're going to go to emergency room and we're going into bait this kiddo or we can make this this lesion be black for a few years until they're you know got grips on things and we can treat it conventionally I think most parents rather their kiddo not be put on a breathing machine because that's safe in a hospital setting but but already in my rotation a little kiddo just there for circumcision you know he had learned just bad and turned into a Bronco spasm and and things can go south and so there's there's not riskless you know I'm saying so that's not ideal me would like to. Be wary of that. All right so I need to really really speed up my talk here in this is a good friend Chad to St It's taken a big increase and we're all called to treat autistic patients and. One thing that I think they need to help us out is we need to not think of it as as as right now to code if you even if you don't dream to completion I hope you don't say sorry go see this person at least provide a small step for that patient provide a small step of desensitisation right come sit in my chair let me blow this air on you and leave the appointment even though if there was some parts and went south. Leave the appointment tell and good job you overcame your fear give that person a good name call him brave right you give a dog a bad name as well hang in there the saying well you praise him and you tell them that they're awesome you tell him they're good you don't that they're brave and they're more likely so the person you're referring to is going to be better and you did your part also out of times when I went to see these guys is I be afraid and I promise I had so much doubt I can't do it I can't do it. And sure you probably can't do it right but God calls us to try doesn't cost to win every time it cost us to try and that's one huge lesson that we can learn. In every part of life that God doesn't call us to to when everything right the results the consequences of our actions are in his hands there in his hands we're just called to do our part you know and it's so easy to be like Hey Carlos how you doing man great to see and he's like gives me the cold shoulder I'm not going to say how to Carlos again because he made me you know but that's not it you know I was vulnerable I stuck out my hand I say Hey Carlos how you do and I extended friendship and I should praise myself I say good job see when you put yourself. You made yourself vulnerable and you did what was in your power to do you do it in part it didn't turn out like you wanted it to with your family member with your spouse with your patient but you did your partner it's all of God's asking. So what are the goals of behavior guidance we're going to deliver a safe place we want to get them to the next step and sometimes we have to deal with kids that rule the house I don't know whose fridge that is but some in that control their kids it's not my house I don't know who said. It is my as an adult in the fridge us all by all those apples by Marc Savard and I just was little munchkins. Hugo level. So dealing with the parents that's a good one that's a hard one. I would say empower the parent even if their own you can win an argument and lose a friend and you can win an argument and lose. A patient and who loses you lose a pair loses the child loses so. I will do what I know is not maybe exactly right for behavior modification and let the parent back and she's just you know totally working against. But I let her have her try and say hey. I like what you're doing here could we do something else here you can't you don't want to you know even if you go in there when say no this isn't going to work is how we're going to do it you're not going to win get the parents on your side it's great to talk to them by themselves parents by themselves if you can and say here's what I'm going to do I'm going to use some voice control I'm going to I'm going to you know if I'm going to try to show do and and show them exactly what we're doing then do it and I'm going to. Later if that doesn't go on I'm going to lose I'm going to use a sterner voice and to say you know this is this is what we're going to do and we need to sit still now OK And so you have all this and it's a it's a practice right it's what we call a practice but sometimes you make things happy make you you make a relationship with the with the person and. And towards the end will talk more about it but you want to empower the pair that's the key one there and. Sometimes you have to read that kid when they're in the waiting room they might look at you and not trust you a bit and you know sometimes if you go in there too strong too soon hey are you doing that such a cute outfit. But if you can normally pay attention to parent you're real nice to the pair oh you know so bad and then you go that So reading faces reading the pair and dynamic is is key talk a lot you statements don't say all right you want to say that you're no All right we're going to sit in the chair you can open your mouth you want to open your mouth you tell me this is what we're going to do. Or and I have to remind all the time are you ready course or not ready you know want to see you. So reasons behavior these are meant to go rug rats and then they they want to go in and they want to they want to get out of there they want to tension from Mom moms are great and they love us but how many of you guys fake sick to get out of school or so when you were little I mean come on those guys are great manipulators they're so good. And when when mom's like Are you sure it isn't her Are you sure you know they're just asking to get more attention in the kid knows that you know you've got mom in the bag or the one I really hate is like they're acting horrible and then you add in like they call this pre-marriage where you'll say OK if you're. Good I'll give you a Nerf gun it's too late by that point you know it's just like Buddy it's nothing for me you know toy or the treasure chest you're going to go home and that's it now now you can bribe or pre-marriage before the bad behavior starts that's the key OK because then we're rewarding we're not rewarding bad behavior right. So antecedent behavior consequences there at the end. Every behavior is a result of a thought before it right so we have to think of where that thought came from. Try to use words like if you feel if you feel pain raise your hand how many of you guys said that ticket don't say that say if you feel any discomfort raise your hand. And that can change a little bit you have a mature patient twelve thirteen you can call what is little bit more I'm going to sting a little bit and it's going to go away but a little kid you know you you distract him and you don't you don't tell him what's going on you're going to put in some you know some silly silly jelly and then you're going to put in a silly spread It's really bitter and I want to get in your eyes close your eyes or whatever your technique is tell show do we talked about that you show in the mirror before you stick in their mouth and you tell him everything is going to do before you do it and you just talk talk talk dark dark dark dark the bad thing is if you don't talk and they get nervous they like to hear you talk. TASS trips this is great for autistic patients when you have a patient you show him one strip it's on a velcro sheet and after the thing is done you've done you flip it over and you turn and turn it around that's done you know we have three more to go and helps them see the end helps and see the end and the end we get to go to talk about we get to go to wherever wherever they love to do you get to do that the and it's a great visual for them and. Task strips those are great to have in the office. This. Preparation make a modeling video or show parents a modeling video the kids I guess we watch this video they know exactly what that is there were a for that the kids liked reading right so get them get them on board and show what they're doing and. So here's some here's some more sometimes OK for another kid to come in and watch their brave older brother or sister do something that's helpful but if they're not brave and they're going to be screaming in the office and if you know a lot of times kids do better without parents back there so if you feel like mom's going to be OK with you being her being in the in the waiting room say hey you know what's best for your kid. But the research is said a lot of times and times do better when there are you OK with that or in the might say Yes Might it is what I'm going to you know not you know. Come on back whatever and a lot of them really are strong about that and. We talk about Internet sedation you know they get all benzodiazepines doesn't give you too much time but it does have its place I would say that this is somehow fading out and we have you know I.V. sedation and. Being in the O.R. the hospitals kind of increasing because it's very hard and takes so much time you have to monitor these patients like every five minutes and write down their vitals and go to sad and tidal C O two. So I don't think I'm going to be doing this much after I get out of residency just to be honest with you but in my habits it has it's it has its place and if any of you guys want this presentation be happy to send you guys this later give me your e-mail or something you guys know about nighters oxide not sure exactly I put in there but you know you titrated out many of us do it I'll be honest with you we go straight to forty percent. Sometimes fifty but you're going to have a little more increase may begin with that. But never gone over over fifty percent and you want to make sure that that bag over inflated not under inflated that it has it's but it's right there in. The middle it's got room to go either way and that night your sock side and and the T.V. in the ceiling that's your behavior management Those are the those are the big ones all this other stuff you know it's an art and when you know you do it sometimes but. I'm just going to tell you what I plan to do and the investment lectures that we had earlier touched on this a little bit but I planned to live followed him Dave Ramsey to live like nobody else is some day I can live like nobody else right so ax my wage. Or well below my way to maybe put away fifty sixty one hundred thousand dollars in vest so that maybe I can buy some rental property I can in and that's that's my point is that we have a couple of houses they're renting for about a thousand two hundred dollars a month and each ouse you can just say about each asking me about twelve thousand dollars a year right ten of those That's my goal and I want ten of those because what now give me about one hundred thousand dollars that I can live on and that will free me up for the Lord's work not to say that what I'm doing dentistry is not the Lord's work it is everybody in every profession is the Lord's work but how great was that in Peru not making a dime do and do it as much as I WANT TO THE LITTLE BIT overrun maybe I'll spend more time on the other ministry the running ministry your mentoring kids whatever it is it would free me up. To do this because like I told you those you know about forty thousand dollars and we had a great life. So contentment is always a big thing. Contentment it's not the destination or place it's basically the car that we're traveling in right and these are some Bible texts that. Shares how important contend this is and that God calls us to be hard workers. And I love this just like Dr White was talking about this morning talking about that light bulb and how the light is brightest at the source right well this is a Jewish custom we're after the Sabbath they kind of do the what's it called here I'm a notes the hundred dollar service where they fill this cup with wine and it overflows right now a cup would symbolize their family that they want God's blessing for them financially and spiritually and but that's not enough they wanted then to overflow and bless others with it. So I hate when people judge other people on the size of their cup they don't know how much they tie their how much they're giving what percentage of their income they're giving to tide they might be giving. You know forty percent of their income to other and we don't know that yet they might be driving a lot Serratia but. What are we paying you know what are we what do we pay and there's no room to judge and we so we don't even spend time comparing comparing is a sickness you know rob you of your joy in life comparing yourself to this person this person this person how much they have God calls us all to be different and different ways he's not calling us all to be the next Mark Finley's no CONUS all to be the next Carlos but. What we're all called to be faithful what God has called us to do right and so that's that's my point in my change in my change that hey maybe I'll get to retire in ten years. Retire in ten years do dentistry but a little bit more on my terms and be not be tied down so a few questions for you what your story all about if your life was a movie would be interesting. Also who's the center of your story is that you because it shouldn't be a lot of pressure and it's a lame lame lame existence if you're at the center because it makes everything miserable because you're comparing yourself and you're a victim put God in the center when you put God in the center your life doesn't have to be great it can be very mediocre or maybe just bad and unfair you can be in prison the whole time but you know in your heart that you did what God put in your path to do. And the stories about him were here to lift him up and it takes the pressure off of you it takes the pressure off of the family situation off of your marriage after your practice because you do what you know best and let God do the rest so in all these and all these questions I think one thing that's going to alleviate everything and bring it back down to what we need to focus on. Is put God first. Put God first you don't know exactly what's best for your family or what's best for your practice but God does. Seek ye first the Kingdom of God and in all these other things will be added unto you so it's tough and there's a video here that I was playing on show and I think I'm going to skip it it's a one of our races in Peru in. A couple minutes so it's about these two kids. And I mean for this to happen we had it is one of like one of our races and I lead the race and they all run the same route every time but they where every time on race day we create a little bit of hype and there's some new people that aren't in a running club we had about sixty kids that would have cards. And were part of our club and awsome. And. And I just happened to be I was I was filming on my phone foreign and ended up getting a lot of footage of these three boys. Giovanni an old water though and I forget the other guy's name but El Dorado was my little you know me and I kind of looked out for this guy he looks like he's four bodies like six or seven. Dads and alcoholics mom's an alcoholic and and he's he's given it his all Mia and. You know I'll play with the video I. This is. Not see any of it speeded up to me out of Washington. This is Giovanni and Jordan. And I ask where's the Eldar though because in the other scenes he was there running with I'm like what happened to. And this is the uphill stretch when you're around that corner at the bottom you can see the finish so this is kind of the last leg and then they're going to take a right turn up the hill they're hurt and they've been I've been watching these kids the whole race and the three miles and and they're they keep going so here's Jordan and Giovanni Where's old why are those the question and here he is. And I'm telling how you look how fast these guys are. And I look at this look at this Eduardo. And I'm I'm like Get him get the next guy get the next I keep going keep going and if you turn this corner you can see the finish line. And it's a great metaphor for how we should view ourselves living in these times you know I'm saying like we have the privilege of knowing the end and we have the privilege of knowing that God is coming soon and it hurts wife is uneasy these patients drive us nuts. But God is calling us to keep going and push you are in complete the race is given to us Hebrews twelve one right run the race. So that is my encouragement to you guys at the end of the day I want you guys too. To know how to get the last one but my last slide just shows a picture of my family. And. And my plan is to fill my cup. But not stop there right we're we're called the good stewards. Are you here own. Is your family yours are the things that we have ours no. God has called us to be managers of the things our bodies our wives our kids our patients and we start thinking of ourselves as owners that's where things go south and it's a lot of pressure being an owner you know I have ownership I mean it's God's and God's going to do with God's going to do and we want to help it happen I don't know why uses us were broken we don't we don't do things very well but it's awesome So that's my plan and this final same is hard work but God's called us to do it and are you willing to do your part and leave the results in God's hands let's pray gently father Lord we're little We're small and were we're trying to do the best we got we want to be the best we can be in our professions and we want to glorify your name sometimes or we get distracted and we need we need our friends when in our family groups like this we need our church members to live to back up and to keep our eye on the prize and to keep running this race because someday it's going to all be known and Lord we want to we want to look back at our time this earth and feel good we don't want to feel we don't want to feel like I did the other day when I painted the cabinets in this oil based paint over a water based or something like that and I spent hours on it only to realise how to scrape it all off in such a feeling of I wasted so much time. And we don't want that feeling we don't want that gut feeling of wasted all this time when I could have been doing significant purposeful work for you so Lord encourage us come into our hearts bless our efforts and create an. Accurate representation. You put on our hearts where you have all your Jesus a name in. This media was brought to you by audio verse a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse if you would like to listen to more sermons leave a Visit W W W audio verse or.

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