tOWARD L

• 10 is sent to you by your Ticonium Laboratory, doctor.

The magazine that covers the whole range of your i nte rests - profess i ona I and personal.

pendents such as a student who earns part of his support, or an aging parent who contributes to his or her own support.

Personal Deductions For this year only, the standard deduction percent­

age rate is raised from 15 to 16 percent. The maxi­mum amount that can be deducted is $2,300 for a single dentist, and $2,600 if married and filing a joint return ($1,300, married, filing a separate return)­unless deductions are itemized.

The Optional Tax Tables for those who do not itemize is temporarily changed this year to include those with taxable income of $15 ,000 or less (for­merly $10,000) . The low-income allowance used with these tables is higher. For a married person filing a joint return it will be $1,900 ($950, married, filing a separate return). For a single person it will be $1,600. A larger allowance can be claimed with each additional exemption. This year, some dentists may benefit by claiming the standard deduction or the low­income allowance when they have not done so before.

Some dentists may be able to create tax savings by "bunching" deductions that can be paid either this year or next year in one of the two tax years. In the year of the larger amount of deductions, they itemize ; then in the other year the standard deductions are claimed. A few examples of the type of expenses that could be paid in either year are medical costs, some taxes or interest, and charity contributions.

Other dentists who will itemize deductions each year will benefit by trying to claim a larger amount of deductions in those years when their tax bracket is higher than usual.

For the first time in 1976, the new tax rules for deductions for child and disabled dependent care will go into effect. This deduction is allowed as an em­ployment-related expense. If you are married and living with your spouse, you both must be gainfully employed-unless one of you is disabled. Employ­ment must be substantially full-time. When you qual­ify, costs up to the limit of $400 a month can be deducted if income is $35,000 or less (this year, still $18,000 or less). When income exceeds this amount, the deduction is reduced by one dollar for every two dollars of income; and the deduction will be com­pletely phased out at an income level of $44,600 (this year, still $27 ,600). So, a dentist who has this de­duction will certainly be able to claim a larger amount next year. Some dentists rna; qualify for the deduc­tion for the first time.

Other Considerations Up until the end of the year, a dentist can get a five

percent tax credit up to a maximum of $2,000 ($1 ,000, married, filing a separate return) on the pur­chase price of a new home that was under construc­tion or constructed before March 26, 1975. If he does

16

decide to try to get this credit, he should carefully check all of the tax rules in advance of the purchase to be sure it will be allowed.

The Work Incentive Program (WIN) credit of 20 percent of most wages paid a worker hired who re­ceives Aid to Dependent Children payments (AFDC) can be claimed from after March 29 , 1975, until July 1, 1976. Note that the employment need not be re­lated to a profession, trade, or business. The credit can be claimed up to a limit of $1,000 for , say, a per­son hired for work in the home.

When a dentist offsets capital gains with losses to determine the amount of taxable gain, he may de­cide it is to his advantage to try to reduce taxable gains by increasing deductible losses, if this is possible.

Claims of personal bad debt losses are ordinarily carefully scrutinized by IRS. It is wise to be sure all of the tax rules for claiming this loss are carefully complied with in advance of claiming the deduction.

This article cannot cover every phase of tax plan­ning. Some plans, such as those for depreciation de­ductions , charity contribution deductions , and others have very complex rules, regulations, technicalities , and exceptions to observe. It is suggested that expe­rienced tax counsel be consulted in any major deci­sion. More detailed information can be studied in IRS publications, which can be obtained free from any IRS office.

P .O. Box 7156 Riverside, California 92503

~4wdt.-DEMCHUCI<

"LET'S TRY BRINGING IN SOME OF THIS FLUORIDE. WHAT HARM CAN IT DO?"

TIC, NOVEMBER, 1975

"

io A Magazine for Dentists, Dental Assistants, and Dental Hygienists

Published monthly by TICONIUM COMPANY DiYision of CMP Industries, Inc .. Albany, New York

Editor Contributing

Editors Cover Artist

Joseph Strack Arthur H. Levine, D.D.S. Maurice J. Teitelbaum, D.D.S. Edward Kasper

NOVEMBER 1975 VOL. XXXIV NO. 11

CONTENTS

DOCTOR, DO YOU KNOW YOUR PATIENT!

Be sure you do! Begin th is all-important

series on dent istry's (your) " special

patients "

"MY THING IS TRAVEL. , ."

You'll enjoy this a ccount, and how-to­

do it advice, by a dentist who lives and

practices abroad

DON'T REMEMBER-FORGET IT!

Why keep the brain crammed with use­

less, outdated informat ion, and painful

memories?

DENTISTRY'S HALL OF FAME

Take a few minutes to mee t two of its

great inventors - Alfred Gysi and

4

7

George B. Snow 8

ItOW TO SAVE ON YOUR INCOME TAXES-BEGINNING NOW!

Things to do for your 1975 and 1976 returns

I aa I MEMBER PUBLICATI O N ae AMERI AN ASSOCIATION OF DENTAL EDITORS

14

Send editonal contr ibutions and totr~spondence to Jo. epn Strack, Box 407, North Chathal" , N.Y. 12132; change-of· ~t~'r22gi' t ." to Circulat ion Manager, TIC, Bo. 350, Albany,

TIC is mlclofllmed by University Microtdms. Inc., 300 N. Zeeb R d Ann Arbor, Mich igan 48106. TIC' s In emat lCnal Standard S. nal Number IS. US ISSN 0040-6716 TIC.

Copynght, l Q75, TieonlUm Company, DiviSion of CM? Industries, Inc., 413 North Pearl St ., Albany, New York 12207

Opinions ~ pre ed by contrihutors to TIC do not nece55 "Iy refl ec t t he views of the publIShers.

Printed in U S.A. by Jersey Pfl "t itlg Co , Inc., Bayonne, N.J. Annual Sub c"ptlOn. $5.00

TIC, NOVEMBER, 1975

DOCTOR, DO YOU KNOW YOUR PATIENT?

Introduction The knowledge and skill that make a dentist an effective health

professional never let him lose a patient to the anonymity of a cavity, an extraction, or a denture.

He knows that the person in his dental chair, completely dependent on his professional thoroughness, is the sum total of the patient's physical, emotional, and social being-and all of its inherent pressures and problems.

Those burdens make millions of men, women, and children den­tistry's special patients, those who require special consideration and care. They include the physically disabled and chronically ill (19 million); the mentally and emotionally handicapped (20 million); the deaf (13 million); the alcoholics (9 million); the mentally retarded (6 million) ; and others.

Because many of these individuals are multihandicapped , there is duplication in these statistics. However, the scope of dental services has been so enlarged in recent years that there is no chance that a dentist's patients will not include a substantial number of special patients.

This problem area in modern dental practice 'ill be explored in a series of articles in Tic, beginning with this issue. The most appropriate article we could find to lead off this series was made available to us by the distinguished Dental Clinics of North America and its talented author. Dentists will read this definitive presentation with great inter­est and professional profit.

It will help every dentist to know, really know, the patient in his chair-special or otherwise. This series is dedicated to that objective.

SOCIOLOGIC AND PSYCHOLOGIC CONSIDERATIONS IN SPECIAL PATIENT CARE

The Dentist, the Patient, and the Family by Rosalynde K. Soble, M.S.W., A.C.S.W.

Assistant Professor and Director of the Extramural Program, Department of Community Dentistry, University of Maryland Schuol of Dentistry, Balti­more.

Most dental practitioners are aware that only a small percentage of the problems they have with patients are rooted in the physical, biological, and technical aspects of their practices. By virtue of the fact that both the dentist and the patient are human beings, socio­logic and psychologic factors are introduced into the dental situation. Their personalities, feelings , attitudes, and behaviors are determined as much by these factors as they are by their biologic needs. The dentist and the patient are also products of their life experiences and social environments. These experiences have been different for both and they have different norms, values , and expectations about life in general, and about the dental situation in particular. This has the potential of creating problems in interaction. When the dentist, and hopefully the patient, are aware of the ramifications of these social and psychologic factors, they will be better prepared to cope with them.1-4. o. R. n

(Copyright by Dental Clinics oj N orth America. Reprinted by permission.)

I

Dentists should recognize that their technical capa­bilities alone will not keep their offices filled with pa­tients. No matter how skillful a dentist may be, he can only practice if he has people who want to be­come, and remain, his patients. Unless he is able to communicate and interact responsively with his pa­tients, his practice will be adversely affected .

As vital as the sociologic and psychologic compo­nents are to all dental practice, these factors have even greater weight in the provision of health and dental care for special patients. This article addresses itself to some of the considerations in the provision of dental care for this special popula-tion.

Emotional Considerations Every dentist sets personal and professional priori­

ties which are related to his individual needs and per­sonality. He organizes his practice to achieve his goals. Therefore, each dental health practitioner treats those people whom he really wants to have as patients, and either consciously or unconsciously rids his practice of those unwanted. There are a variety of ways by which this selective process is accomplished. Some mechanisms utilized to discourage patients are direct, others are subtle ; some are purpose­ful, some are not consciously planned. The undesir­

able patients may be referred else­where; they may have excessively long delays in obtaining dental appoint­ments; they may have to accept ap­pointments at inconvenient times; they may find their dental work unusually costly and feel that the dentist seems unpleasant and disinterested; or they may even find the actual treatment procedures particularly painful.

There are a variety of ways to de­fine "special patients." Each dentist can make his own categorization to meet his particular needs, locale, and dental environment. For the purpose of this paper, special patients are de­fined as patients who are dentally han­dicapped, and/or handicapped for dentistry. "Dentally handicapped" re­fers to patients who have some gross condition or defect in their oral cavi­ties which necessitates some special dental treatment consideration; i.e., children with rampant caries. "Han­dicapped for dentistry" refers to pa­tients whose oral health may be con­sidered within the normal range, but who have some physical and/or men­tal or emotional condition which may or may not prevent them from being treated routinely in the dental situa­tion. An illustration of this would be cerebral palsied patients with motor

The dentist as a private practitioner has the right to control patient popu­lation in the way which is agreeable with his own needs, temperament, and lifestyle. In his professional capacity, he also has the responsibility to be concerned that all people needing or wanting dental care are provided with this opportunity. Often this conflict­ing dichotomy presents a dilemma which causes many dentists some dis­comfort in their reflective moments.

"It must be kept in mind that the term special pat ients encompasses people with a variety of cond itions wh ich range along a continuum, from mildly to severely affl ided ."

Special patients, by virtue of their dehabilitating conditions, have a re­sistance level which is often low. They

may be prone to the spread of infection and disease from poor oral health and inadequate dental care, since a relatively small percentage of the patients re­ceive adequate dental therapy. This fact is correlated with the large number of dentists who are loath to accept them as patients.]:: Many dentists do not under­stand why they react negatively to having certain peo­ple become part of their patient popUlation. This has special validity for dentists who decide that they do not wish to treat special patients. The serious conse­quences of limited dental facilities for special patients should motivate the dentist to understand the reasons that may deter him from providing this much needed dental care.

coordination problems that necessitate other than rou­tine handling in the dental operatory. To clarify fur-

. ther, a patient with a missing lower extremity who functions well with a prosthesis and could be dentally treated in a routine manner would not be considered a special patient. On the other hand, a person with one arm, who even with a corrective device might have difficulty handling a toothbrush, would be defined as a special patient. These categories are not mutually exclusive. A patient can simultaneously be handi­capped for dentistry and dentally handicapped. Spe­cial patients are people who may be mentally retarded, cerebral palsied, epileptic, heart and stroke victims, diabetics, aged, or emotionally disturbed. With this comprehensive approach, dentists who shy away from treating other than "normal" people may ultimately find , through longevity of practice and the normal vicissitudes of the aging processes, that they and many of their hitherto "normal" patients may become spe­cial patients.

2

Special patients are rejected because the dentist is a human being who is a product of his culture. He has been influenced and socialized by the society , community, and family of which he is a part. Many of the cultural values which he holds make him more prone to enjoy contact with people who are attractive,

TIC, NOVEMBER, 1975

as closely as possible probable income and deductions for the year. Then the tax bracket rate can be deter­mined with a reasonable degree of accuracy.

If collections have been slower than usual-and many patients have postponed getting needed dental work done-this could have an effect on income. A dentist may find that all of these factors will result in a lower tax bill than he had earlier anticipated. If he expects it to be higher next year, then he will benefit a good deal from planning purchases for the practice in order to have as many deductions as possible in the following year of expected higher earnings. On the other hand, those dentists with higher income and tax bracket than usual may want to -create deductions for needed items for their practice this year. Other den­tists, for reasons of their own, may wish to create higher deductions this year.

When it appears that income for this year is much higher than over the four preceding years, a dentist should determine whether he is eligible to average his income for a tax saving. Or, he may be very close to the income figure where averaging will produce a sizeable tax saving. When this is the case, it will be to his advantage to increase his income as much as possible in advance of the end of the year. He may be able to do so by intensifying collection efforts, trying for more capital gains, or other measures. In some cases, this will have an effect on tax saving plans.

There are indications that there will be some tax changes made by the government late this year. Ordi­narily, these changes are for following tax years. However, there is a strong possibility that some of them may be retroactive to this year. If a dentist has all the information necessary about his own tax situa­tion, he can act promptly. He may be able to make some tax savings, or at the very least, cancel any adverse effect the changes may make on his tax bill.

Depreciation and Investment Credit Near the end of the year, a dentist may need to

purchase some capital assets for his practice. How­ever, it may make no difference in practice earnings whether or not the assets are purchased late this year or early in the following year. Both this year and next year the investment tax credit will be 10 percent in­stead of the usual seven percent.

When he wants to increase his deductions for this year, he can do so by purchasing the assets this year. He will be able to get a very high depreciation deduc­tion by claiming the additional 20 percent first-year depreciation deduction for those assets that qualify, and claiming the double-declining balance method of depreciation. This will leave increasingly less de­ductions in the following years . He can, in addition, claim the 10 percent investment credit for qualifying assets.

Another dentist may want to purchase the assets

TIC, NOVEMBER, 1975

next year in order to create larger deductions then. He can still claim the 10 percent investment credit next year. Another accelerated method of deprecia­tion is the sum-of-the-years digits method. Those who want to spread deductions over the useful life for larger deductions in following years can do so by using tIle straight-line depreciation method.

When planning for tax savings for capital pur­chases, a dentist should keep in mind that the tax credit is claimed in the year of purchase, but limited to the tax liability. There are carry-back and carry­over rules for deduction of excess credits. The addi­tional 20 percent first-year depreciation deduction is also claimed in the year of purchase. Remaining de­preciation charges are spread over the useful life of the assets .

Furthermore, depreciation charges are deducted from practice income and, in turn, reduce taxes at the applicable tax rate. But, the investment tax credit is deducted dollar-far-dollar directly from the income tax bill.

Direct Practice Deductions Another way of reducing the tax bill for this year,

or planning to reduce the tax for next year instead, is the timing of outlays that are deducted in their entirety in the year of purchase. This would include such costs as buying supplies, making repairs, paying association dues, consulting experts such as a lawyer, tax counsel, and so forth.

Many such outlays can just as well be made this year or next year. It may pay a dentist to make a check of the list of deductible items. If he does not, he may find himself purchasing items or making out­lays that would have yielded a greater tax saving if he had only waited a few days, or, conversely, had acted a few days earlier.

The plans discussed here will be equally applicable to other income-producing sources, such as rentals.

Personal Exemptions and Dependency Deductions

It is even more important than in former years that a dentist makes certain that all of the tax rules are met to claim all deductions for dependents to which he is entitled. If he loses an exemption because the more-than-one-half of support or some other rule has not been met, he not only loses a $750 deduction from taxable income, but also, for 1975, a $30 credit deducted dollar-far-dollar from his tax bill. Only one $30 credit is allowed for each taxpayer, even if the taxpayer can claim a double deduction such as those who have reached 65 years of age or older, and those who are blind by IRS definition.

A careful check of support records may reveal that a small amount more support is needed in order to meet tax rules. This is important in the case of de-

15

anisms to make life manageable. The dentist who can differentiate the genuinely warm loving mother of a special patient from the basically hostile overprotec­tive mother will be able to intelligently assess her use­fulness to him and the patient during the dental pro­cess. Patients who harbor resentful feelings toward a parent sometimes use a public place, like the dentist's office, to behave in a manner which will cause the parent to be embarrassed. The dentist who recognizes and is sympathetic to these dilemmas will treat the parents, as well as the patients, with understanding, kindness, and respect.

Conclusion The function of the dentist is to maintain the oral

health of his patients. His competence in fulfilling this service depends on more than his biologic knowledge and technical skills. Effective patient care is linked to a vast array of sociologic and psychologic deter­minants. These dimensions have special importance in the dental care of special patients.

REFERENCES

1. Baber, E. G., Crook, G. H., and Schwabacker, E.: Personality correlates of periodontal disease. J. Dent. Res., 40: 1961.

2. Bloomfield, J.: The initial interview. Dent. Clin. N . Amer., 6 : November, 1962.

3. Borland, L. B. : Odontophobia-inordinate fear of dental treat­ment. Dent. Clin. N. Amer., 6: November, 1962.

4. Epstein, S.: Psychological implications of anesthesia. Dent. Clin. N. Amer., 6: November, 1962.

5. Goffman, E. : Stigma, Prentice-Hall, Englewood Clffis, N.J., 1967.

6. Goldberg, H ., Ambinder, W. J., Cooper, L., and Abrams, A L.: Emotional status of patients with acute gingivitis. New York Dent. J., 22, 1956.

7. MacGregor, F. c.: Some psycho-social problems associated with facial deformities. Amer. Sociolog. Rev., 16:629 and 638, 1951.

8. Manhold, J. H., and Jones, M. B.: Preliminary study of social attitudes in relation to dental caries formation. Washington Univ. Dent. J.: 22, May, 1956.

9. Plainfield, S.: Psychological considerations in prosthetic den­tistry. Dent. Clin. N. Amer., 6: November, 1962.

10. Richardson, S. A, Hastorf, A H. , and Dornbusch, S. M.: The effects of a physical disability on a child's description of himself. Child Develop., 35, September, 1964.

11. Richardson, S. A, Goodman, N., Hastorf, A. H ., and Dorn­basch, S. M. : Cultural uniformity in reaction to physical dis­abilities . Amer. Sociolog. Rev. , 26:241-247, 1961.

12. Seath, R. A.: The Socialization of Stigmatized Persons into Deviant Roles. Presented at annual meeting of the American Sociological Association, Boston, 1968.

13. Soble, R. K., and Chaiklin, H.: Social work and preventive dentistry. Paper presented at the annual meeting of the Na­tional Conference of Social Welfare. Atlantic City, N.J., May, 1973. -

University of Maryland School of Dentistry

666 W. Baltimore Street Baltimore, Maryland 21201

HOW TO SAVE ON YOUR INCOME TAXES - BEGINNING NOW!

by Harold J. Ashe

T his year a dentist will need to take into account what effect the 1975 tax changes will have on his in­come tax bill in advance of any year-end, tax-saving actions.

Consider a simplified example of what could be the effect on an income tax bill when the temporary tax credits will create deductions this year. Suppose tax credits claimed include a $120 credit for four exemp­tions, $300 for the 10 percent investment tax credit for assets purchased for the practice, and $320 for a Work Incentive Program credit for wages paid to an employee who is a recipient of Aid for Dependent Children-all directly deducted dollar-for-dollar from the income tax bill. Suppose the tax bill is ordinarily

14

about $7,000. When the $740 total of these credits is deducted, this leaves an amount owed of $6,260. If, in addition, a home has been purchased that quali­fies for the home buyer's credit of five percent of the purchase price, and the maximum of $2,000 allowable credit can be claimed, the tax bill will be further re­duced to $4,260.

A dentist who uses the standard deduction percent­age rate for his personal deductions will have a higher percentage deduction rate this year. The Optional Tax Tables also allows higher deductions.

In addition to taking into account such changes, there will be the necessary preparations to get all in­formation that must be included in order to calculate

TIC, NOVEMBER, 1975

amenable, and whose values and beliefs most closely resemble his own. Without being fully conscious of it, dentists, like other people, including the personnel in his office, have strong emotional blockages. These blocks may cause a resistance to being with defective, physically unappealing, difficult, or unpleasant pa­tients who may make the dentist feel depressed and uncomfortable. Excluding these patients from the practice is one way. of avoiding these feelings.

Research studies show that people react strongly to stigmatized people, especially to those with visually apparent defects, e.g., facially disfigured cleft palate persons. 5, 7, 11 Few are psychologically and emotion­ally indifferent to handicapped or dis-

tient has a source of dental care, for failure to do this is an abdication of his professional responsibility.

Financial Considerations There are other considerations which are part of

the dentist's decision to treat special patients. The dentist who is emotionally capable and positively motivated to work with these patients should give thought to the rationale for the decision that is made regarding the dental fees. Each dentist manages this to his own satisfaction. Some argue that the special patient is treated as most other patients, and the charges should thus be the same. Others feel that

working with special patients takes abled people. All of us react with greater or lesser degrees of intensity. Some dentists who accept special pa­tients often emotionally over identify with them to the extent of becoming ineffective in their professional capaci­ties to provide dental services. Still other dentists are disturbed by handi­capped patients to the point of being overly cautious and overly fearful. Consequently, they may work slowly and ineffectively, making the patient's treatment mnecessarily prolonged and difficult. Some dentists try to deny these uncomfortable feelings and un­consciously employ psychologic de­fense mechanisms which make them seem unfeeling, detached, and unsym­pathetic toward the patient and his family. If dentists become cognizant and sensitive to their own reactions, they may be able to overcome their emotional blockages to some degree. They may then be personally comfor­

"Another aspect of special patient care is the concern of tho dentist about the impact that these pa­tients may have on others in the waiting room:'

more time and that the fees should be increased. This philosophy is based on the principle of being paid com­mensurate with the time and effort spent with each patient, and since the dentist's time is valuable, he is entitled to be paid for the time spent with each patient. The point open to discussion, however, is whether the treatment of special patients necessarily takes longer than usual. In many situations, particularly during the initial dental visits of some special patients, the ap­pointments may need to be of longer duration. Still, some special patients may be as easy to treat as other pa­tients. Many trainable and educable mental retardates who are used to rou­tines are especially amenable dental patients. A clinical but scientifically undocumented observation is that many of these patients have a higher pain threshold than other patients. Un-

table enough to be responsive to their own and their patients' needs, and may no longer need to exclude special patients from their practices.

Other dentists who are unable to recognize and cope with their biases and prejUdices will not be ef­fective in their professional roles with special pa­tients . These professionals might do better to limit their practices by screening out the special patients whom they are unable to treat. There should be no stigma or censure attached to this course of action. It is a legitimate professional behavior pattern which the dentist can and should choose when necessary. It is the preferred course of action and of maximum benefit to both the special patient and the dentist under specific circumstances. However, when the dentist decides he is not going to treat the special patient, as a member of the health professions he has the responsibility to make a referral to another dentist or facility. He also has the professional obligation to follow the referral process until he is certain the pa-

TIC, NOVEMBER, 1975

der proper conditions, some of them are able to tolerate long dental appointments, and are often ideal dental patients. It must be kept in mind

-that the term special patients encompasses people with a variety of conditions which range along a con-tinuum, from mildly to severely afflicted.

A third school of thought regarding setting fees for special patients is held by dentists who believe that fees should be lower than average. These practitioners maintain that the majority of special patients with longterm chronic conditions have histories of con­stant medical contacts, with the accompanying costly medical expenses. These proponents, because of their altruism and compassion, feel that such extreme finan­cial pressures on the patient and his family should be seriously considered by the dentist when he makes a decision about his fees for dental treatment. They urge that the dental fees should be set as low as possible.

These are three fundamental orientations to the (Continued on Page 10)

3

Living and practicing abroad:

" "MY THING IS TRAVEL • • • • By Thomas H. Booth, D.M.D.

O n the occasion of living abroad for the third time, it occurs to me that I may have something to report, particularly to people sharing varying amounts of in­terest in travel. However, if my enthusiasm seems a little excessive, feel free to call this a case history and not a report.

I'm a dentist, an occupation generally considered prosaic by people outside of the profession and by some within it, myself included. To me the thought of fully sustained attendance in a practice until retire­ment, death or whatever comes first is anathema. Re­tirement is no doubt a golden time, but there are earlier, even more noble years marked by perhaps a sharp reduction of responsibilities. I'm referring to that happy time when children reach maturity, putting us somewhere between 45 and 55, by no means an advanced age, and the juices of youth still run at a fair clip. It's an age when we're capable of doing and enjoying things that may not be possible when those elysian days of retirement arrive.

Someone has said that adult happiness lies in the fulfillment of childhood dreams. I agree, and think that those dreams should be honored. If they were of den­tistry or medicine or law, then read no further, you've already got it made. Most juvenile dreams, however,

were of becoming a pilot, climbing a Himalayan peak, raising horses, sailing a boat to the South Pacific, or drifting down the Mississippi on a raft, etc. Whatever falls into your childhood-dream category can prob­ably be accomplished in a year or 18 months. The economics of its completion probably will be less ex­pensive than a corresponding period of illness-which is another way of saying why discriminate against health in favor of sickness?

My thing is travel, and it involves seeing as much of the world as possible on my own terms, and not within the group-oriented-togetherness schemes that have become the identifying feature of the tourist in­dustry. I also like dentistry and have been able to use it to provide me with the kind of travel I require, as at this writing I am living and practicing in Hong Kong. Before this, it was the Republic of Zaire (ex­Belgian Congo) and prior to that in Australia. Each experience was a happy one, and so my wife and I are repeating for the third time. We have learned a few lessons from these itinerant years tha! should be passed on, but judging from the number of American dentists overseas, it's an unpopular activity. Thank goodness it is, for if everyone shared my enthusiasm, the world would be glutted with people like me. There

"Hong Kong is an exotic, sophisticated place , a real crossroads .... "

4 TIC, NOVEMBER, 1975

ing and keeping the dental appointments. Transpor­tation arrangements to the dentist's office may be complex. Sometimes a family member must lose time from work to bring the patient to the office. It is also the family who conditions the patient to the dental experience. The attitudes they implant in the patient, either consciously or unconsciously, will affect the level of acceptance or rejection of the patient towards the experience. Often, too, it is the family which pro­vides the dentist with the necessary social and medical history of the patient. The dentist may decide to utilize the family member as an active participant in the management aspects of the patient's care during the treatment process. In some cases, it is the family members who have to assume the major responsibility for the home dental care of the patient. Since the family interacts with the dentist and the patient on many levels which impinge on the oral health of the patient, knowledge about the family and the dynamics of the family relationships falls into the province of the responsible practitioner.

The family of a person who is disabled shares the risks and impact of his illness. The presence in a fam­ily of someone who has a chronic condition manifests major changes in the structure, patterns, relationships and functioning of the family unit. The parental mar­ital relationship as well as the sibling-parental rela­tionships are affected. Adjustments need to be made continuously to accommodate the emotional ramifica­tions and difficult management aspects that are in­herent in this kind of home environment. The sharing of the responsibilities, problems, and satisfactions can unify and enrich the family. Still, the continuous pressures can become too burdensome for the family and be disruptive to warm solid family relationships. It is difficult to ascertain who may be the one who is suffering the most, the affected patient or the family. At best, this situation places increased demands, and has extensive impact, on the lives and lifestyle of these families. The dentist may have better rapport with the patient and the family if he is cognizant of their stresses and realities.

Since many special dental patients have defects whose etiology stems from congenital prenatal condi­tions or birth traumas, it may be prudent to examine the responses which are triggered by these occur­rences. Expectant parents place great emphasis on producing a healthy normal baby. It becomes an ex­tremely difficult and emotionally disturbing experi­ence for parents to be faced with the reality that in some way their newborn infant is less than perfect. Minor correctable defects are often magnified out of proportion because the parents' reactions stem from deep emotional bases. At the time when these parents require the greatest support and reassurance, their worries are often intensified by the way the people around them react towards the "damaged" baby. The

TIC, NOVEMBER, 1975

physician, other hospital personnel, family, and friends are uncomfortable. This embarrassment and discomfort is overtly or covertly communicated to the parents. In turn, the uncertainty and fears of parents about their malformed or defective infant are intensi­fied significantly. The attention of the professional personnel and others is focused on the pathology of the child. The parents are reinforced towards direct­ing their attention on what is wrong with the baby rather than on what is healthy and normal. If this focus is sustained as the child matures, warping effects on its psychologic growth and development occur. The youngster then becomes more disadvantaged, be­cause along with his original disability, he is also emo­tionally deprived and disadvantaged. The effects of this chain of events are reflected in the dental situation.

The parents of a defective child have to struggle with their feelings about themselves and their child. Some parents with emotional maturity and stability accept the child, loving and nurturing him to grow as normal as other youngsters. Other parents feel guilty and blame themselves for the defect in their child. Some react as "martyrs" who feel they were "picked" to carry this special kind of burden. These and other parents may have strong hostile feelings toward their malformed offspring. This inability to respond to their child in the loving manner that is socially acceptable compounds their guilt feelings. Their stresses are awesome and they employ numerous defense mech-

"The fam il ies of these pa tien ts playa spec ial role in the d enta l situat ion. The degre e of the ir involvement may vary from margina l to vital, but th ei r contrib ution, impact, and problems merit co ns ide ra tion ."

13

cious for the dentist to give the patient his full atten­tion during their time together. This helps the patient to know that the dentist is truly interested in him as an individual.

With particular patients, the verbal aspects of com­munication may not elicit a response. In this case, the dentist should use nonverbal techniques to reach this type of patient. Tactile communication is one of the most satisfactory techniques to establish contact. By this method, the patient who may not respond to other kinds of communication usually gets the message of the dentist's concern when he feels a reassuring hand on his shoulder or a repetitive stroking motion on his hand. The patient understands from this kind of touch the the dentist cares.

Dentists, like other people, sometimes confuse the concepts of mental limitations and emotional insensi­tivity. People who are mentally defective still have emotional awareness. These patients will understand whether they were being treated kindly or unkindly, and if the dentist is a friend or foe. Their perception of the dentist and his staff may make or break the dental visits. There are moments in the treatment process when the dentist may inadvertently be inflict­ing pain on his patient. Some special patients cannot express verbally or even indicate the location of the pain. It is therefore essential for the dentist who wants to avoid producing a painful episode for the patient, to know how the patient indicates that he is having discomfort. Watching for signs, such as the clenching of the fists , the stiffening of the body, tears , and excess perspiring, tells the dentist about the pa­tient's reactions to the treatment.

Consideration About the Person Who Is the Special Patient

Besides having specific reactions to his dental prob­lems, to the dentist, and to the dental environment, each patient comes with definite feelings about him­self as a person. The patient's self-image has signifi­cant dental ramifications. It is advantageous then for the dentist to be aware of factors which shape the personalities and behaviors of his patients, as well as some of the strains having specific impact for the spe­cial patient.

It has been indicated that a person is the product of his accumulated life experiences and social environ­ment. Numerous studies support the fact that people with varying chronic and handicapping conditions are often viewed negatively by other people. I :! How a person feels about himself is very much related to how he perceives the way others feel about and relate to him. The level of self-esteem of the special patient is connected to these kinds of variables. A patient whose experiences have been predominantly positive, is likely to acquire an adequate sense of self-worth, security, and confidence. These attributes influence

12

his ability to cope successfully with the situations he encounters, viz., the dental situation. Conversely, the patient whose experiences have been basically un­pleasant and negative will have a very low self-con­cept. 10 This patient is less capable of coping with all the elements in the dental experience. Some people with longterm limiting conditions have been denied the diversity of stimulating experiences and exposures which are important to normal human growth and development. Their circumscribed exposures to nor­mal stimulation, coupled with the effects of expe­riences which the individuals perceive as rejections (from the significant persons in their environment), prevents many special patients from developing to their maximum potential as human beings. They are sometimes denied the opportunity to participate to the fullest extent of their capacities in the mainstream of life. They are often unsure of themselves and not in­clined to trust people. The dental visit is often trau­matic for these patients and their dentists . The patient comes to the dentist with certain ideas about what he thinks of dentists and has perceptions about how he thinks the dentist reacts to him. All of these feelings relate to the behavior of the patient. Some of the negative feelings are a reflection of previous traumatic medical experiences the patient has had. Thus, moti­vation, compassion, patience, and ingenuity are needed on the part of the dentist to establish the trust­ing relationship needed to understand the patient.

Patients with similar debilitating conditions react differently from each other. One patient may be treatable in a routine manner; the other may not. The crucial issue is not the actual disability of the patient, but rather the patient's ability to handle his feelings about himself and his disabling condition. Many pa­tients are able to minimize their difficulties and differ­ences by utilizing their strengths and resources in the dental environment. Other special patients are too uncomfortable to relate well to the dentist and may reject treatment. It facilitates patient management if the dentist knows what is happening with his patient and the reasons the patient behaves in a given manner. By being "tuned in," the dentist can adjust his way of approaching different patients who have different needs. Dental care for special patients must be as­sessed and provided on an individual basis.

Considerations About the Family of the Special Patient

The families of these patients playa special role in the dental situation. The degree of their involvement may vary from marginal to vital , but their contribu­tion, impact, and problems merit exploration.

Many special patients have conditions which neces­sitate heavy dependence on their parents and other family members. Often the family of the special pa­tient must manage the practical arrangements of mak-

TIC, NOVEMBER, 1975

already is enough sameness in the world today-uni­sex, collective activity, and meaningful, trendy to­getherness of all kinds-it's our differences that I think are important, and the main reason people travel.

The Problems-and Possibilities Admittedly a performance of this kind isn't all that

easy to accomplish. What does one do about his home? What happens to his practice? Will it work economically? Will both husband and wife react hap­pily to this largely unknown future? These are the questions and implications which cause its unpopular­ity. Furthermore, licensure restrictions in most coun­tries make it difficult for an American dentist to be­come registered for practice. In addition, if you do find a job abroad, you'll find that it doesn't imply any economic advantage. Sounds like kind of a dumb thing to do, doesn't it? And it certainly is for most people.

But for the few who require a foreign experience in depth far beyond that possible for the casual tourist, there are a number of possibilities that may be of in­terest and should be described. The easiest place for an American to become registered for practice is Australia-also it's probably the most friendly. We spent a year there and practiced dentistry as an asso­ciate with very capable and congenial people, as well as doing some part-time teaching. Economically we made it on income earned there, nothing left over, as we are essentially beginning again-new friends, new patients, a used car, and a modest furnished flat. That first experience had its moments though, we were new at this matter of being residents abroad, and the loneliness of those first few weeks was unpleasant. But as time passed, we became nearly as involved socially as life at home had been. Friendships formed in those days have become strong and lasting attach­ments. Australia then was a place where being a Yank earned you a pat on the back, where you could still make a five-cent phone call, the beer was full bodied and cold, the miniskirts were short, and the beaches magnificent.

If there was a major problem with that first ven­ture, it was leaving a home and practice in premature haste. One cardinal rule of living abroad happily is to leave affairs at home in an orderly condition. Leave yourself an out in the event that things don't turn out exactly as planned. Remember that the pleasure in living abroad is directly proportionate to the quality of preparation for it. I found a dentist to take over my practice, and he did a commendable job of looking after my patients, but patients choose their dentist and sometimes resent being transferred to another while their dentist is off dong his thing.

Our return from Australia was by a slow deyious route through the South Pacific-Solomons, New Guinea, and Indonesia, where I tested Hemingway's

TIC, NOVEMBER, 1975

remark, "If you want a bum show, return to your old front." On my part, there was no nostalgia in return­ing to the scene of my World War II activity-I wanted to see what I missed the first time, and we saw it this time happily from the decks of copra boats, small coasters, canoes, and DC-3's. Hemingway's comment in no way applied to me.

How to Leave Home Back in practice again in the United States with the

taste of honey still strong on my palate I lasted about a year, until a physician friend who publishes medical textbooks and shares my point of view told me about a hospital in the Congo which needed a dentist. I think I got a letter off that same day, and after an appro­priate exchange of correspondence, they offered me a job. On this occasion we took more time with our home affairs, found better renters for our house, and considered the future state of my practice. Patients did accept my absence once, but a second time might overtax their tolerance, so I very carefully sold my practice, and left power of attorney in the hands of a trusted accountant.

We were off again, but there were fewer unknowns about this venture, for we were provided with trans­portation, excellent housing, a car, and a reasonable salary. My job too was challenging and involved the training of auxiliary personnel in expanded duty pro­cedures as well as providing clinical dentistry and surgery to hospital patients and limited operative pro­cedures for expatriates. The staff at this hospital in Kinshasa was international-French, Belgian, Chi­nese, Swedish, American, British, Haitian, and Afri­can-a collection of congenial people with whom our social life began the day of arrival. French was spoken by all and was a condition of employment. Lingala, the local dialect, was used also, and I'm glad to have lived in the environment of other languages long enough to come away with ability in them.

"Cultural Shock" Not everything was beer and skittles, however, for

life in the Third World environment of an emerging black nation can have its moments. This matter of cultural shock is a real thing to contend with . What starts out as being colorful, exotic, and quaint, can in a short time become inconvenient, troublesome, and unpleasant. Most people adjust happily in a month or so, but we've witnessed first-time foreigners who arrived thrilled with the prospect, but packed up and left in haste after less than a month. The lesson to be learned from this is to advise any dentist or physician who is at all unwilling to live with the incon­veniences of a tropical climate, attendant health haz­ards, and unfamiliar local customs, to not consider living in the newly developing countries-go to Ha­waii for two weeks instead.

During our time in Africa we visited neighboring

5

(Hong Kong Tourist Association)

Tai Po Kau, a small settlement on the edge of Tolo Harbour in the New Territories of Hong Kong.

countries, traveled with some difficulty to see the pyg­mies of Zaire, traveled with ease to game parks in East Africa, and swam on the fine beaches of Kenya and Tanzania. Also, we spent a holiday in Europe, and when my employment was over we came home the long way around through the Seychelles, Ceylon, Malaysia, Indonesia, to a wet welcome in Australia, then on to New Zealand, and Tahiti.

One Year later-On to Hong Kong This time a close friend at home invited me to asso­

ciate in his practice, even while realizing that I had taken on the reputation of itinerant dentist. Less than a year later I was deep in correspondence with a class­mate and old friend , a Chinese practicing in Hong Kong who offered me a place in his practice as asso­ciate with attractive terms. Again we left with matters at home under control and with my former associate's blessings. We took our time crossing the Pacific and spent considerable time in Micronesia-magnificent islands with certain sociological problems, but for connoisseurs of the South Pacific, here are found some of the best islands and the least spoiled-Majuro, Ponape, Truk, Yap, Palau, etc. Guam, 28 years later was a disappointment, but Saipan certainly was not.

As of now we've been in Hong Kong six months­I'm happy and productive in my office, and we live comfortably in a mid-level flat with a harbor view. Hong Kong is an exotic, sophisticated place, a real crossroads where, like the Cafe de la Paix in Paris, if you wait long enough everyone you know will be seen, on the Star Ferry between Hong Kong and Kow­loon. We've had our share of guests here-of which we never tire, and conversely, I think that we could drop into almost any major city in the world, and a brief phone call would net us a drink, a meal, a bed, and people glad to see us.

G

Probably we'll stay another 18 months, and in the process hope to gain entrance to Red China (the Peo­ple's Republic of China), do the provincial islands of the Philippines by small boat, see the east coast of Malaysia in better detail, and then come home by freighter or a series of them through Borneo, the Celebes, Moluccas, and if our livers can stand it, Australia again.

There are employment possibilities for dental grad­uates of American schools in the Panama Canal Zone, American Samoa, Territory of Papua-New Guinea, Trust Territories of the Pacific, Guam, Zaire, Nigeria, and perhaps others. Some of the overseas oil compa­nies may have openings. Licensure either full or provi­sional may be obtained in parts of Australia, Republic of South Africa, Hong Kong, Switzerland, and Great Britain. The U.S. Internal Revenue Service will prob­ably excuse you from income earned abroad if you are a bona fide resident of a foreign country, not work­ing for an American institution, and if your absence is for at least a calendar year, but better yet for 18 months.

Dentists interested in humanitarian activities will find numerous assignments available with missionary and other philanthropic groups including the Peace Corps. An extensive list is available from the Ameri­can Dental Association's Council on International Re­lations, including the mechanics of becoming regis­tered in other countries.

Few reading these remarks are likely to immedi­ately push off and become foreign residents. The only ones who might be tempted are those with an existing predisposition. They are my targets, travelers not tourists; they'll recognize themselves.

111 Robinson Road Hong Kong

TIC, NOVEMBER, 1975

sitate particular accommodations to be treatable. The degree of the dentist's perceptiveness to the needs of these patients correlates with his chances for success­ful treatment. The dentist has to be sensitive to a wide array of concerns ranging from the most ele­mental to the most complex. One critical question to which the dentist must address himself is "What is the capacity of this patient to function in the dental situation?" The dentist needs to be able to make the fundamental distinction between that which the pa­tient is unable to do versus that which the patient is unwilling to do. Unless the dentist is able to make a realistic evaluation of the patient's capabilities, his level of expectation for the patient will not be in keep­ing with the patient's ability to perform and cope with the dental situation. To work well with the patient, the dentist has to ascertain the patient's ability to comprehend and to follow his directions. A patient who is physically incapable of keeping his mouth open would be handled differently from a patient who re­fuses to keep his mouth open because he is fearful. The approach of the dentist should vary with the motivating reasons for the patient's behavior.

The more the dentist knows about the patient, the better he will be able to treat him. While this is true for all patients, it is even more important with special patients. Taking a comprehensive medical and social history of the patient is a key to knowing the patient and building rapport and trust. Therefore, an initial and essential aspect of the treatment of special pa­tients is history-taking. The dentist needs to make an investment of time to talk with the patient and/or his family in order to learn about the patient's condition, personality, characteristics, lifestyle, relationships, in­terests, and reactions. Utilization of this information to establish a good relationship with the patient and the family makes a crucial difference between success­ful and unsuccessful dental treatment.

A quick visit to the waiting room to greet the pa­tient and his family gives the dentist the opportunity to make observations which help him decide how to proceed with the patient in the operatory. By observ­ing perceptively, he learns useful kinds of information, i.e. , if the patient can sit in the chair or if the patient can verbalize. He can also use that opportunity, along with the interview, to make assessments about the parent accompanying the patient into the treatment area. This helps him decide whether the parent should assume an active or passive role in the dental opera­tory. To evaluate effectively, the dentist must be able to recognize the clues which reveal the relationship between the parent and the patient, for if the rela­tionship appears to be a good one, the parent can be the dentist's most valuable resource in the manage­ment of the patient. If there is evidence of a poor relationship, the presence of the parent in the opera­tory may be detrimental.

TIC, NOVEMBER, 1975

Communication Considerations Dentists are concerned with the inability of some

special patients to communicate as normally as other patients. Special patients, like others, have a wide range of differences in these communicative abilities. Some of these differences relate to physical incapaci­ties, mental defects, and emotional factors. If the dentist can identify the etiology of the patient's com­munication problems, he is better able to utilize com­munication techniques that will be effective. For ex­ample, if the patient could not follow instructions because he had a hearing problem, the dentist could write his directions, and hopefully, the patient would be able to respond. However, if the problem was caused by a mental deficiency, writing would not be a useful mechanism to reach the patient.

Dentists who treat mentally retarded and other spe­cial patients with communication difficulties can use a variety of communication techniques, e.g., wording directions simply, and avoiding the use of double directions, such as "tilt your head back and open your mouth." The "tell," "show," and "do" technique is of value to the communication process. Talking with the patient about his particular interests tends to relax him and foster good rapport with the dentist. Learn­ing and using the name the patient likes or is accus­tomed to hearing helps personalize the professional contact. Pacing the dental visit in tune with the pa­tient's mood and time frame is rewarding. It is judi-

"Besides having specific reactions to his dental problems, to the dentist, and to the dental environment, each patient comes with definite feelings about himself as a person. The patient's self­image has sign ificant dental ramifications. It is advantageous then for the dentist to be aware of factors which shape the personalities and behaviors of his patients, as well as some of the strains hllving specific impact for the special patient."

II

SPECIAL PATIENT CARE (Continued from Page 3)

establishment of dental fees. Each dentist makes this important decision on the basis of his individual atti­tudes and needs, and ultimately decides on that which seems right to him.

Pragmatic Considerations Another aspect of special patients care is the con­

cern of the dentist about the impact that these patients may have on others in the waiting room. They also are unsure as to appointment scheduling. Some spe­cial patients look and behave like everybody else who comes into the dentist's office. These patients may need little, if any, special handling. However, there are patients, e.g., brain-damaged youngsters or pa­tients with neurologic disorders who have uncon­trolled motor coordination, who look and behave dif­ferently. The dentist may fear that the "normal" pa­tients might resent the special patients, or become disturbed enough to consider changing to another of­fice. There are many pragmatic approaches to this potential problem, one being for the dentist to set aside a particular morning or afternoon to see only special patients. When scheduling appointments, the dentist should learn if the patient has particular rest periods or special hours of the day when he is at his best. If the dentist takes advantage of this information and schedules appointments accordingly, the situation in the dental office has a greater chance of proceeding smoothly. It is valuable, too, if the dentist and his staff become familiar with community resources which provide educational, welfare, recreational, medical, and social services for these patients and their families. This knowledge is helpful for referral purposes, and helps the dentist identify special patients. If, for ex­ample the dentist's receptionist routinely asks for the name of the school which a child attends, she can identify a mentally retarded or cerebral palsied patient at the point of initial contact. The receptionist can also inquire if the patient is ambulatory and if special arrangements are needed for the patient to reach the office. It is important to learn if the patient has physi­cal limitations and/or mechanical devices, e.g., a wheelchair, which may make the dentist's office inac­cessible to him because of its physical and spatial structure. The layout of the dentist's waiting room, the availability of someone to help occupy the patient until he is seen in the operatory, the possibility of scheduling appointments that limit the waiting time, and the availability of a place for privacy between the patient and the dentist are considerations which affect dental care. These are dimensions of special patient care which can be managed effectively by advance planning and organization.

The satisfied special patient and his family are usually longterm, lucrative, appreciative patients for

10

(The Detroit News)

.... . other dentists are disturbed by handicapped pa· t ients to the extent of being overly cautious and overly fearful."

the dentist. These families often find it so difficult to locate dentists who will care for their children that the dentist is usually assured that most of these patients will probably remain loyal to him. The inner satis­faction that many dentists receive when working with these grateful patients and their families extends be­yond the financial reimbursements received for their services. This emotional payoff is not to be underesti­mated as an important personal and professional re­ward for the dentist.

Experienced dentists have learned that a number of special patients can be treated with little if any deviation from their customary routines. In the care of disabled and handicapped patients , it is a good treatment premise to proceed with the dental treat­ment as normally as possible until some special de­parture is specifically indicated. The important point is that although there may be differences between usual and special patients, there are also many similarities.

The dentist, like others, should avoid making gen­eralizations about his patients and their particular conditions. Stereotyping patients into rigid classifi­cations fosters inflexibility in the dental treatment situation. It tends to smother the ability of the profes­sional to be open-minded about the needs of each indi­vidual patient and hampers him from successfully treating the patient. The extent and severity of the handicap and patients' reactions to their conditions vary along a continuum. While one mental retardate, for example, may function well and be an ideal pa­tient, another with greater defectiveness or less coping capacity may be a management problem for the den­tist and be incapable of being treated in his office. There are a range of conditions, a range of behaviors, a range of attitudes, and a range of modalities of treat­ment. Dental management and treatment decisions can only be made on an individual basis after adequate knowledge about the patient is available.

There are special patients whose conditions neces-

TIC, NOVEMBER, 1975

Don't Remember-Forget It! by Maurce J. Teitelbaum, D.D.S.

T he brain, that wrinkled mass of nerve tissue in our ancient techniques when there are implants to learn skulls, is the superstructure of the human body. As about and long lists of niceties in practice adminis-they say in boxing parlance, ounce for ounce it's tration that beg for our attention? numero uno. The heart, reproductive system, and Of course, remembering the name of the butler in lungs are important but without the brain they're the silent film, "The Cat and the Canary," or the nothing. Why then, if the brain is so special, do we theme song for the old Amos and Andy radio pro-neglect it? I mean, why do we keep it crammed with gram, or the batter who made the last out in the 1931 so much useless, outdated information and painful World Series may be important if you expect to be memories, that it often becomes difficult to remember a contestant on a trivia show, but you can hardly ex-important matters? The brain can only retain just a pect this sort of knowledge to come up in an every-fraction of the knowledge it is fed, so isn't it foolish day conversation if you live to be a hundred. Then to remember anything you don't need to remember, there are those aching memories every dentist would or want to remember? like to forget. Like the set of full dentures you had

Practically speaking, this superduper, computer- to remake three times, or the dental assistant who like organ functions, in part, like the drawer in a filing developed a set of x-rays without unwrapping them, cabinet. For, ever since we started using our brain, or perhaps the Edsel you bought. These are the sort we've been filing away bits of information every wak- of things we'd like desperately to forget. ing moment of our lives. So naturally there comes a How can we learn not to remember the thousands time when the drawer gets overcrowded. When that upon thousands of useless bits of information and occurs, and it happens early in life, to file away any experiences that are neatly filed away in our skulls? new, important information means squeezing and Hypnosis has been suggested by some researchers cramming the stuff in. So what happens? The brain on forgetting but there is always the danger of un-is filled up with so much old, antiquated, and unnec- covering subconscious memories that have charit-essary material that it becomes increasingly more ably been long forgotten, the recall of which would difficult to find a place for new, important, relevant only add to our burden. After all, what's the point of items one wishes to remember.

A Universal Problem This seems to be a universal problem among adults

over 35, which is why memory courses have become so popular. But what we really need is a course in "forgetting." Instruction that could make you forget all the nonsense and inane material that clutters up the cranium, so that there would be no problem in remembering the new things. Unless we learn to for­get, the flotsam and jetsam of the past just floats along its merry way in the crevices of our brain. The trou­ble, in essence, is that the old facts and experiences have been with us so long that they have priority in our mental recall processes. Like the computer, we ought to be able to clean out our brain every so often to rid it of the endless store of worthless material and moldy memories that have accumulated. For exam­ple, why on earth should we have to remember the name of our kindergarten teacher, the first car we drove, or the slogan for Camel cigarettes? And why be pained with the memory of penny candy, the five­cent cigar, or the three-cent postage stamp? As den­tists, our minds are cluttered up with all of this use­less knowledge and more. Who needs to remember things like the vulcanite denture, the use of phenol and silver nitrate to sterilize cavities, or how to plug a molar MOD with gold foil? Why remember these

TIC, NOVEMBER, 1975

substituting one set of wornout memories for others? There is a simple Mexican airforce exercise that

may help you to forget. You bend from the waist until the upper torso is parallel to the ground. Then, at the count of three, with hands firmly clasped behind your back you sprint full tilt into the nearest wall. I have visited people in the hospital who have tried this method and from their inaudible groans I gath­ered that they do not recommend it.

Fortunately, there is a sure fire-way to clear the mind of all useless information and painful memories. It was taught to me by a distinguished professor of psychology at one of the leading universities. In 10, two-hour sessions, all the things I wanted to forget vanished from my mind and my head felt as light as a 300-watt bulb. Today, my brain is no longer clut­tered with trash and I can absorb any new facts like a young sponge. No more painful memories of ado­lescent years or investment losses. Once this tech­nique is mastered, forgetting becomes as easy as remembering. What's more, anyone can accomplish this feat by a little self-discipline and practice.

To begin With, there are 12 basic steps to forget­ting. First, write down some of the things you want to forget. Start with an even amount, like five hun­dred. Second, put them in order of urgency as to which you want to forget the most. Third . . . third ... third ... third ....

7

Inventor of the Anatomical Articulator

ALFRED G YSI (1865-1957)

Alfred Gysi's primary contribution to dentistry was the anatomical articulation of full artificial dentures by means of an adjustable and most ingeniously con­structed articulator. However, Dr. Gysi had a broad curiosity which led beyond the profession to interests in the color and stereoscopic and microscopic aspects of photography, as well as in astronomy and botany.

Alfred Gysi was born in the little mountain town of Aarau, Switzerland on August 31,1865. His father was a photographer and an instrument maker. The young Alfred must have inherited a high degree of ability in the areas of science and mathematics. His aptitude for practical application was sharpened acutely by the thriftiness which was habitual in his home and among the people of Switzerland generally. As a boy he wanted a microscope in order to investi­gate the wonders of nature. Lacking funds, he ground his own lenses from glass which he himself melted and prepared. Later, while a student at the University of Geneva he extended this interest to histology and Gysi eventually became one of the European lead­ers in this field.

It was logical that a young man with such ingenuity should choose dentistry for his life's work. After taking the courses available at Geneva, home of the only Swiss dental school at that time, he traveled to the United States and spent the years 1886-1887 at the Pennsylvania College of Dental Surgery. There, he graduated at the head of his class of eighty students with a D.D.S. degree and had his thesis, Dental Caries under the Microscope, published in the April, 1887 issue of Dental Cosmos. Soon thereafter Gysi easily passed the examinations of his homeland and achieved the Swiss National Diploma.

Early in his dental practice, the young Gysi encoun­tered the unsolved problems of making artificial den­tures satisfactorily. He accepted the challenge and began to search for methods to overcome the obstacles by delving into the fundamental nature of the difficul­ties in order to isolate and to solve them. Finally, it dawned on him that success would be more likely at­tained if he considered denture construction as an engineering problem rather than by imitating the nat­ural human dentation. Through this approach he obtained data concerning the stresses and strains to which artificial dentures are subjected and thereby learned better methods for securing stability.

8

DENTISTRY'S HAll Of fAME

When the dental school at Zurich was founded, Dr. Gysi was asked to lecture on the normal and patho­logic anatomy of teeth. Later he was appointed head of the Department of Prosthetics. It was there and then he seriously began his work on the problems of articulation and occlusion.

After more than two decades of such work, he suc-ceeded in devising an occluding frame, which he termed an ar­ticulator, for the ar­rangement of artificial teeth in harmony with the strains manifested by the individual pa­tient. In 19 13 and 1920 Alfred Gysi made extended visits to the United States to familiarize himself

with American techniques and to elucidate his concept of denture construction based on his research with nearly 20,000 denture cases. Professor Gysi received rousing welcomes whenever he appeared before American dental societies. The records of attendance at his talks are still unbroken.

It was Professor Gysi's personal ideal to devote himself to the search for truth. In viewing his mani­fold achievements, it can be stated that he fulfilled his ideal to the utmost. After receiving a countless num­ber of honors and awards during his long life, Alfred Gysi died on November 9, 1957 in Zurich at the age of ninety-two.

COMING UP IN DECEMBER TIC "Paradise-Bought by a Toothache"-the real­life story of how a dentist came to own a tropical isle .... "Consumerism Comes to the Waiting Room" -the patient's new image as a customer. ... "Time for a Change?"-when and why it can be right to give your office a new look.

TIC, NOVEMBER, 1975

Inventor of the Face-Bow

GEORGE B. SNOW (1835-1923)

George Snow was a dentist of unusual skill but, in addition, he was also an inventor, industrialist and teacher of great merit. He is best known for his in­vention of the face-bow and of a dental vulcanizer.

George Burwell Snow was born at San­dusky, Ohio on Au­gust 28,1835. The next year the family moved to Buffalo, New York where his father, a physician, re­ceived instructions in dentistry from Dr. Uriah Dunning and later took up the practice of den­tistry in 1838. As a lad, George had a great flair for mechanics. He was introduced to dentistry when he began working in his father's office under the precep­torial system of the day. George was quick to realize that college training would be superior to working in a dental office. Accordingly, he enrolled in the Penn­sylvania College of Dental Surgery where he received his D.D.S. degree in 1859.

After graduation Dr. Snow practiced in several small communities, but he desired further, postgrad­uate, knowledge. He moved to Chicago where he learned about porcelain block work, and then to Al­bion, Michigan where he studied the techniques of rubber vulcanization. Snow also attended medical lectures at the University of Buffalo.

Dr. Snow was most effective and at his best in his study, laboratory or workshop rather than in a dental office. Those who sought him there could always ob­tain his most thoughtful attention. Basically, Snow was modest and unassuming. He often found it diffi-

TIC, NOVEMBER, 1975

cult to express his ideas in public. Because of this he was not immediately and appropriately appreciated by the profession.

In 1865, together with Dr. T. G. Lewis, Snow in­vented and began manufacturing the Snow and Lewis automatic dental mallet. Later, with others, he or­ganized the Buffalo Dental Manufacturing Company which he managed for some years. He became presi­dent of the company in 1882. But in 1901 he with­drew to organize the Snow Dental Manufacturing Company.

Earlier, in 1892, Dr. Snow had helped to form the Dental Department of the University of Buffalo. Later he served the University as Librarian and as Clinical Professor of Mechanical Dentistry. From 1904 until his retirement in 1913 he was Dean and Professor of Prosthetic Dentistry. During George Snow's connection with the school he worked contin­ually for its advancement, giving of both his time and resources. Often he neglected his personal affairs and those of his manufacturing company to help further the school's development.

As early as 1864, Dr. Snow was one of the organ­izers of the Buffalo Dental Association. He was later

active in the Western New York Dental As­sociation. Upon retir­ing from the Univer­sity, Dr. Snow estab­lished a fund to award prizes for excellence in the field of prosthetics in order to further the study of this branch of dental service. While living in retirement in Long Beach, Califor­

nia he still devoted his considerable energy to research upon the properties of India rubber during vulcaniza­tion and he published his conclusions in 1920 and 1921.

Dr. Snow received patents for many of his inven­tions. His face-bow of 1889 was one of the most famous of them. It transferred mechanically the rela­tionship between the upper denture foundation and the opening and closing axis of the patient's lower jaw to the articulator (an occluding frame). His last patent, which was for the compensating vulcanizer, was issued in January, 1918 when George Snow was eighty-three. Dr. Snow passed away in Long Beach on February 15, 1923.

George Snow's useful inventions, literary contribu­tions and educational efforts are still appreciated. He left a heritage of invaluable service to the dental pro­fession. In point of fact, his life was full of achieve­ments.

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