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Helping You Be a Better Dentist

Perspective: The root of all happiness

I didn’t always want to be a dentist. The decision was one I struggled over. When I was in college and starting to give serious attention to dentistry as a career, I talked to two dentists that practiced in my hometown.

Dr. Vaughn

Dr. Vaughn

I asked them both the same question, “What’s dentistry like? Do you enjoy it?” It seemed simple enough to me at the time, but the answers were surprising and confusing.

The first dentist was a regular at the retail store I worked at during the summer months. He scoffed at my question. And as if he had said it a thousand times before, his routine began, “Well . . . it’s realllly hard. And dental school was like four years of boot camp.” He said it slow and drawn out. Like he wanted me to soak in all the misery he had experienced with his life choices.

I kept waiting for the second half of the sentence. The half with the uplifting part of his story. The part he would tell young aspiring dentists so that they wouldn’t regret committing their college years to studying. But that second half never came. He was done. This man’s relationship with his entire career was summed up in 14 words.

The second dentist in town, a man about the same age, also had something to say. “Oh you’re going to love it! There’s not a better profession out there.” So I shadowed him for the day. This man loved what he did, and he made sure everyone around him knew it.

There’s a reason this story sticks out to me after all these years. You see, these two men practiced in the same town. They were about the same age. Graduated from the same dental school. Their patient bases and daily routines were very similar. So what was going on? Why such drastic differences? I couldn’t understand it.

And then I got to dental school. And I saw how easy it is to be drowned by the pounding waves that dental school hurls on top of former straight-A students. The truth of it all is that dental school IS hard. Dentistry IS hard. Make no mistakes about it.

But we all go through it, and then we come out a little different at the end of it. Some of us become model alumni for our schools. But then some of us never want to step foot in the building again. Some of us want to tell everyone how much the profession has done for them. But then some of us just want to work 2 days a week and think about something else the rest of the week.

At the root of this problem is something that everyone has. Its name is “perspective.” And what’s so great about perspective is that you have the power to control it. You mold it, and then it molds the world around you.

In the VA dental clinic that I work at currently, a guy comes in everyday at 4:20 p.m. to collect the trash. And every day as he is dumping all the smaller trashcans into a larger trashcan, he is repeating the phrase, “EVERY day’s a great day!” And he is absolutely incredibly sincere about it. People smile just seeing him walk through the door. They shout the phrase right back at him. “EVERY day’s a great day!”

It’s about perspective and perspective is contagious.

Let’s be honest, I’m new to the game. Two months ago I was getting my Class II line angles critiqued by three different people who all had different things to say about those same line angles. But I tell you the truth when I say dental school was some of the best times of my life. And I can’t imagine what I’d be right now if it weren’t for the people I met and the friends I have and the choices I have made that led me here.

I think about those two dentists often. I’ve talked about them many times before. And I am so thankful that one man’s poor perspective didn’t turn me off from a career that will ultimately change my life and the course that it takes.

So if someone tells you tomorrow they are applying to dental school, what do you say to them? Do you tell them, “No don’t do it, save yourself!” as I have heard a thousand times before? You’re joking . . . but you’re not.

Or will you tell them about all the fun you had in school. And how much better you are at absorbing information on the fly. At how confident you are now in stressful situations that most other people would fall apart in. How about all the special people you met and the lifelong friendships you made? Or the fact that you can get up in front of a crowd now without hearing your teeth clatter from sheer debilitating anxiety.

Or if you were a part of a class similar to mine and every other dental school class that ever existed, what about the classmates that met each other in school and are now married? What about how proud you are to say you witnessed the entire relationship develop and you watched them say their vows as you sat in the fourth row?

Do the rose bushes have thorns? Or do the thorn bushes have roses?

Four years of boot camp? Or something much more. . .

Everything you do and everything you see is framed within the context of perspective. You get to choose what that perspective looks like. But choose wisely, because it could be the difference between a happy career . . . and a miserable one.

Dr. Joe Vaughn is a New Dentist Now guest blogger. He grew up in Alabama and recently graduated from The University of Alabama at Birmingham School of Dentistry in 2015. He now lives in Seattle, Washington, where he attends the General Practice Residency at the University of Washington. Two cups of coffee, writing and indie music are everyday occurrences for Joe. Go Seahawks and Roll Tide!

One technique to address five features in dentistry

It is mechanized isolation and suction. We have all heard about it, seen advertisements, read about it, and many dentists are now using it. I won’t mention specific brand names or expound on the different systems but I do want to go over the topic of mechanized isolation systems.

Dr. Moon

Dr. Moon

Developments in isolation and procedure techniques are changing dentistry — FAST. For centuries, dentists have been trained and coached in treatment delivery techniques that employ a four-handed approach requiring an assistant to be consistently present chairside. However, things change. Whether it is automobile manufacturing processes or heart bypass surgery techniques, things change over time. I believe dentistry is in the first 10 years of what will probably be at least a 20-30 year process of transitioning to consistently employing and teaching mechanized suction and isolation techniques.

Though human assistants are vitally important to the delivery of dentistry and will probably always be needed for certain aspects of care, consistent use of mechanized isolation systems quickly addresses at least five crucial areas in an ever-changing field:

1. Consistency: Use of mechanized isolation systems does not eliminate human factors but it does decrease their impact. Consistently being able to “work in” an emergency patient although your assistant is busy can help in an environment where it seems many patients are less loyal to their long time provider and ready to see the first dentist that will get them in for treatment.

2. CAD/CAM: Mechanized isolation systems are not only good for the dentists. Anyone, including assistants, working with modern CAD/CAM dentistry or digital impression techniques can benefit.

3. Overhead Expenses: Costs of supplies and providing treatment consistently go one direction—up. Save on overhead by using mechanized isolation systems, or put that savings toward paying that really great assistant or hygienist to help you in multiple rooms instead of sitting chairside throughout entire procedures.

4. Resin Restorations: I was consistently taught in school that though most people don’t really want amalgam restorations these days, amalgam restorations are beneficial because they can be stronger to occlusal forces over time, and sometimes-in a wet environment-you just can’t place a good resin restoration. Well, the wet environment situation just doesn’t happen as often when I use mechanized isolation techniques and I have found 90  percent of my patients prefer “tooth colored” restorations.

5. Surgery: Performing surgical procedures for patients in need can not only help a lot of people, but also be a huge practice builder. I have found that I can consistently perform surgical procedures with mechanized isolation and suction that would definitely require sedation and a throat-pack otherwise. The difference for the patient can be thousands of dollars saved, and weeks less of discomfort. People seem to be getting less patient and more “Who can help me NOW?” oriented. When you can produce consistent safe results for patients in emergency situations everyone wins.

Incorporation of mechanized isolation systems and delivery techniques can be very beneficial to patients, dentists and dental team members. Give it some thought.

Dr. Brenden Moon is a New Dentist Now guest blogger and currently serves as Chair of the Illinois State Dental Society New Dentist Committee and sits on the Board of the Illinois Academy of General Dentistry. He began practicing in western Illinois after completing dental school at the University of Mississippi in 2007, and enjoys participating in organized dentistry on the state and national level. Dr. Moon practices in both Public Health and Private Practice settings and is a Fellow of the Academy of General Dentistry, International College of Dentists, Academy of Dentistry International, and the Pierre Fauchard Academy.

Creating positive space: An essential for your office environment

This post is for Tiffani Horton, and for everyone else who is fighting a battle on the inside.

I’m against watching the news. Other people can watch the news all they want to. That’s fine. I just don’t want to watch it myself.

Dr. Vaughn

Dr. Vaughn

I don’t want to watch the news because buried in every news reel is a sad story. A story that reminds me I’m not invincible, I live in an imperfect world, and that sometimes bad things happen that I cannot control.

And unfortunately, regardless of whether or not you watch the news . . . sometimes a sad story still finds you.

In dental school, you rotate through many clinics. You meet a lot of faculty and a lot of patients and a lot of staff. And what’s nice about all this is that the conversations aren’t always about what X-rays you want to take or whether or not you’ve made the right diagnosis. Sometimes you talk about your weekend or what you plan to do once you graduate or how good the new restaurant in town is. You form this unique bond with all these different people, and it eventually creates this special thing with its own label.

The other night, a good friend sent me a message that told a sad story. Someone from my dental school had just lost her battle with cancer. Her name was Tiffani. A dental assistant that I, along with everyone else in my class, had weekly interactions with.

Ms. Tiffani Horton

Ms. Tiffani Horton

Tiffani was more than a name or a dental assistant. She was a friend, a wife, a mother, a person with thoughts and wants and emotions and ambitions. She talked to some of us like she had known us for years. She helped some of us get patients so we could take our licensing exam and become dentists. She was very much a part of our dental school family.

But the thing about all of this is that I had no idea that Tiffani was fighting this battle. She had liver cancer and was undergoing chemo. All while I was still in school. There were conversations I’m sure that we had, where she was living with this horrible disease . . . and I did not know.

Buried in every news reel is a sad story. But what I’m learning is that buried in every sad story is a truth that I need to know.

Because me and you and everyone we know are all the same. We all have bad days. We get bad news. We go through hard times. We hit rock bottom. And then we have to go out in public and try to be strong and keep it together.

Tiffani teaches us that you never really know what someone is going through.

What does that mean for us as we try and figure out this New Dentist world? It means that we have the vital responsibility of being aware. Of keeping social sensitivity as a priority within our practices. Because our staff will have bad days. Our patients will tell us horrible stories from their pasts. Our business partner might be dealing with chemo treatment or secretly going through a heart-wrenching divorce.

And as people who have dedicated their careers to serving others, we need to create space that allows people to escape the troubles of their daily lives. What does this look like? At its core, it’s being aware and paying attention. Picking up those social cues from your staff. Treating everyone in your office with the care and respect they deserve. Not letting your own troubles affect the way you talk to and interact with the people around you.

From the modern corporate office in Chicago to the paper-chart practice in rural Alabama, you can contribute to making the world a better place just by changing the environment of your dental office. A good dental office is one where honesty, respect, care and love are infused in its fabric.

Because you never really know what another person might be going through.

Dr. Joe Vaughn is a New Dentist Now guest blogger. He grew up in Alabama and recently graduated from The University of Alabama at Birmingham School of Dentistry in 2015. He now lives in Seattle, Washington, where he attends the General Practice Residency at the University of Washington. Two cups of coffee, writing and indie music are everyday occurrences for Joe. Go Seahawks and Roll Tide!

Stressed? Create and maintain a health balance

Prioritizing the demands of work and your personal life can often lead to stress, unhappiness and reduced productivity. While stress can sometimes help us perform under pressure and motivate us to do our best, there are real physical and mental consequences associated with chronic stress.

eating lunch at a deskIn the dental office, you may face various stressors. Handling patients, performing intricate procedures or managing tons of paperwork on a daily basis could all lead to increased levels of stress.

There are a variety of steps you can take to reduce both your overall stress levels and the stress you find on the job and in the workplace, according to the ADA Center Professional Success. These include:

  • Track your time. Pay attention to your daily tasks, including work-related and personal activities. Decide what’s necessary and what satisfies you the most. Cut or delegate activities that are unnecessary or can be completed by other members of your staff.
  • Leave work at work. Make a conscious decision to separate work time from personal time.
  • Manage your time. Organize household tasks efficiently, such as running errands in batches or doing a load of laundry every day, rather than saving it all for your day off. Put family events on a weekly family calendar and keep a daily to-do list. Do what needs to be done and let the rest go.
  • Bolster your support system. At work, join forces with co-workers who can cover for you — and vice versa — when family conflicts arise. At home, enlist trusted friends and loved ones to pitch in with child care or household responsibilities when you need to work overtime or travel.
  • Eat right and sleep well. Eat a healthy diet, include physical activity in your daily routine and get enough sleep. Set aside time each day for an activity that you enjoy.
  • Develop an appointment schedule that best suits you. Most of us go through the day using a “push through” approach, thinking if we work the full eight to 10 hours, we’ll get more done. Instead, productivity goes down, stress levels go up and you have very little energy left over for your family. Schedule a break throughout the day to walk, stretch or just relax.
  • Influence others. If you notice that a patient is anxious or fearful about a procedure, tell them you understand and instruct them to breath with you. Bringing down their anxiety levels will allow you to be at ease during the procedure.

Top 10 dental treatment presentation mistakes

Dr. Don Deems, a columnist, speaker and author, shared with ADA Center for Professional Success the 10 most common mistakes when presenting treatment.

Center for Professional Success“As a certified professional coach to dentists, I also know too well the myriad of differing philosophies of practices, the plethora of ‘do it my way’ treatment presenting methods and the challenges we dentists have in working with our team members, who are vitally important to our success,” he wrote.

Here are the top 10 mistakes:

  • Mistake 1: Failure to listen to the patient.
  • Mistake 2: Incomplete diagnoses.
  • Mistake 3: Herding patients in — and out — of your practice.
  • Mistake 4: “Explainitis”, better known as explaining, explaining, explaining with little feedback or time for questions from your patient.
  • Mistake 5: Rushing the presentation process.
  • Mistake 6: Delegating the treatment presentation.
  • Mistake 7: Diagnosing based on prejudice.
  • Mistake 8: Not answering patient’s questions directly and truthfully.
  • Mistake 9: Substituting media-based treatment explanations for developing a trusting relationship.
  • Mistake 10: Promising treatment you cannot reliably deliver.

To read more about each mistake, click here.

ADA Success program aims for connection

Seventeen member dentists, including several new dentists, attended an ADA Success Speaker Training program July 24 at ADA Headquarters to hone their facilitation and public speaking skills.

The ADA launched ADA Success, an all-new program for dental students offering a series of programs on topics most relevant to students today.

Each program is one-hour in length and is presented by a volunteer dentist or other subject matter expert. The programs are presented at no charge to students or dental schools by the American Dental Association and/or state and local dental societies. ADA Success helps students prepare for life as a dentist — good choices now, great dentists later. Program topics include managing debt and wealth; practice management for all dentists; all about associateships; future of dentistry; finding a job; and understanding employment agreements.

Friday’s attendees are among the total 47 speakers in the ADA Success speaker corps. Additional training will be offered in September.

For more information, or to schedule a program, contact ADA Office of Student Affairs at 312.440.7470 or studentaffairs@ada.org or visit ADA.org/successprogram.

Check out the photos from Friday’s Success program below:

New Dentist Conference, ADA annual meeting inspire new dentists, dental students

Westwood, Calif. — While many 2015 dental graduates are busy looking for or settling into practices, one of their fellow graduates is urging both them and dental students to mark some days in early November on their calendars.

Dr. Mendoza

Dr. Mendoza

The New Dentist Conference, which for the first time will coincide with the ADA annual meeting, which takes place in Washington, D.C. from Nov. 5-10. New dentists can participate in both meetings this year and experience all ADA 2015 has to offer, featuring high-level networking opportunities during Leadership Day; a new dentist reception at Penn Social; inspiration from keynote speaker Daymond John, entrepreneur and “Shark Tank” co-star; an exclusive, customized continuing education track featuring real-time interactive technology and more.

Dental students and new dentists alike should make every attempt to attend both events, said Dr. Kristopher Mendoza of the UCLA School of Dentistry Class of 2015.

He should know, considering that he is the immediate past president of the American Student Dental Association and has been an active participant in two past ADA annual meetings.

“It’s a great time to recharge and see what’s beyond dental school,” Dr. Mendoza said.

The 25-year-old dentist, who has just begun a three-year residency in dental anesthesiology at UCLA, said that while the advantages of attending the annual meeting are myriad, one in particular is especially useful for dental students and new dentists.

“One of the greatest benefits for students at the annual meeting is definitely networking with other dentists and students,” Dr. Mendoza said. “Everyone there is extremely helpful, helping the next generation of dentists. They want to see you succeed.”

New Dentist Conference 2015There are several reasons why connecting and interacting with students and more established dentists is important, Dr. Mendoza said. One is that dental students close to graduation and new dentists are seeking jobs, and he has found that some of the established dentists have looked at dentists to join their practices or even sell their practices to.

A second reason is that the ADA annual meeting exposes current and new students to a national community of dentists who provide perspective and inspiration. Attending dental school can place students in a bubble but going to a conference with hundreds of other people who had gone through the experience or were going through the experience invigorated him, he said.

“It was my break,” Dr. Mendoza said. “It helped keep me going. You’re not the only one going through it. It gave me a better outlook on the dental field.” It helped Dr. Mendoza because when he grew up in Fresno, California, he didn’t have any dentists in the family to relate to.

Dr. Mendoza gets asked frequently from younger dentists and dental students if they should join the ADA. “I would challenge them to explore all that being a member offers,” he said. “The value far exceeds the cost.”

Registration for ADA 2015 is open online at ADA.org/meeting.

For a list of courses planned, visit eventscribe.com/ADA/2015.

Search for #ADADC on Twitter and Facebook for more on the ADA annual meeting.

Bang for Your Buck! Prioritizing CE opportunities as a new dentist

We knew all along. We knew there were things we were not learning while we were in school. Now, we’ve made it out. We are practicing dentists. We’ve climbed the mountain, celebrated, taken a deep breath, and turned around to find ourselves at the bottom of another mountain. We know there are things we don’t know. Now what? How do I decide where to start? How do I prioritize what CE warrants my time, effort and money?

Dr. Moon

Dr. Moon

Before elaborating on choosing CE, let me say this: First of all, give yourself a break. You don’t have to save the world your first year as a practicing dentist (even though it kind of feels like you can once you’re treating more than 2-3 patients per day). Use your training to approach cases and treatment conservatively as you build up your confidence and skill level. Don’t get in over your head early. Personally, I believe I spent about six months focusing on my job prior to taking any CE after school.

Once you’re ready to get back at it, make CE choices that benefit you and your patients. After some time practicing, you should have a feeling in your “gut” that if you just knew how to __________ or ________ your patients would benefit and you would feel like a more proficient dentist. Once you have that feeling you are more than halfway there.

I have found that asking myself the question: “Is this good Bang for My Buck?” has consistently helped me make good decisions about how I prioritize my CE. I consider three areas when answering this question to myself:

1. Will learning ____________ benefit the majority of my patients, or a few?

2. Is this topic something very limited or specific, or something I can build upon in the future?

3. Is there a hands-on component to this course, or will I potentially leave this course without the confidence I need to implement what I was suppose to learn?

Answers to these questions usually guide my decisions. I prefer to attend CE that offers benefit to the largest number of patients possible, on a topic or area that can consistently be built upon or integrated into multiple procedures, and especially those that include a hands-on component.

Early on in my career, I found myself focusing on CAD-CAM dentistry and bone grafting procedures. I had come to the realization that the majority of my patients would benefit if I increased my skills in these areas. Also, a basic foundation in these topics is beneficial, but you can learn an extensive amount with either, and continue to build your skills and expand the number of billable procedures you provide. Again, once you know what you want to learn, incorporating a hands-on component will make you that much more confident as you implement your knowledge and new techniques in clinical practice.

For new dentists looking to pick up some valuable CE, I suggest that these two areas are not a bad place to start. Incorporating CAD-CAM dentistry into your practice opens up a lot of treatment options and office scheduling benefits that are not available without it. Also, implant dentistry continues to develop and become a more commonly selected treatment option. Bone grafting and socket preservation procedures help patients obtain optimal treatment results, can often be performed quite easily, and will in many cases be the difference between success and failure concerning fixed prosthodontic and/or implant treatment options. Go get that Bang for Your Buck!

For more information on online and in-person continuing education opportunities, click here.

Dr. Brenden Moon is a New Dentist Now guest blogger and currently serves as Chair of the Illinois State Dental Society New Dentist Committee and sits on the Board of the Illinois Academy of General Dentistry. He began practicing in western Illinois after completing dental school at the University of Mississippi in 2007, and enjoys participating in organized dentistry on the state and national level. Dr. Moon practices in both Public Health and Private Practice settings and is a Fellow of the Academy of General Dentistry, International College of Dentists, Academy of Dentistry International, and the Pierre Fauchard Academy

OSHA updates workplace poster

Are you an employee dentist? Do you know your rights?

The federal Occupational Safety and Health Administration unveiled a new version of the employee-rights poster OSHA-covered dentists and other employers must display in a conspicuous place where employees can see it but said employers need not replace previous versions of the posted notice.

OSHAThe new version of the poster “Job Safety and Health – It’s The Law!” is available without charge and in English and other languages at osha.gov or by phone at OSHA’s toll-free number 1-800-321-6742 or the OSHA publications office (202) 693-1888.

The poster is available in Chinese, Korean, Nepali, Polish, Portuguese and Spanish. The Polish and Portuguese versions are available online only. OSHA regulations do not specify or require employers to display the OSHA poster in a foreign language. However, OSHA encourages employers with Spanish-speaking employees to also display the Spanish language version.

For employers in a state with an OSHA-approved state plan, there may be a state version of the OSHA poster. Federal government agencies must use the Federal Agency Poster.

The poster informs workers of their rights and employers of their responsibilities under the Occupational Safety and Health Act. The poster was updated to include new reporting obligations for employers, who must now report every fatality and every hospitalization, amputation and loss of an eye. It also informs employers of their responsibilities to train all employees in a language and vocabulary they can understand, comply with OSHA standards and post citations at or near the place of an alleged violation.

The last poster update was published in 2007.

A question of ethics

Some issues that a new dentist might face may include:

It is my first time doing a procedure that I want to incorporate into my practice: how can I do that ethically on my first cases?

When should I refer? Are there ethical considerations if I don’t refer?

At what point should I send the patient to a specialist? When and how do I tell a patient their treatment should continue with a specialist without losing the patient’s confi dence or trust? As an ADA member, what is my ethical obligation to my patients?

Dr. Ishkanian

Dr. Ishkanian

We invited Dr. Emily Ishkanian to share perspectives relevant to clinical experience. is the ADA New Dentist 14th District representative and representative on ADA’s Council Ethics, Bylaws and Judicial Affairs. The ADA Principles of Ethics and Code of Professional Conduct (the ADA Code) can offer guidance to help new dentists answer ethical questions, Dr. Ishkanian said.

“My reputation, my name and my license are too valuable to risk,” Dr. Ishkanian said in describing several real world practice situations she encountered. Dentists are faced with challenging ethical dilemmas in day-to-day practice. However, new dentists are placed in especially precarious positions when faced with what seem to be a choice between acting as defined by the ADA Principles Professional Responsibility and possibly losing their job.

Some ethical situations include the following:

Advanced procedures
When you are asked to complete procedures and your gut tells you this isn’t a treatment you feel comfortable performing, you have the option to refer to another practitioner who is more skilled in the procedure. Not only should this be an option, but it may actually be an ethical obligation. Ultimately, as the dentist, you make that call, because only you know your capabilities and you are responsible for making sure you do no harm to your patients. Recognize that referrals don’t make you a weak clinician, but rather show that you value the patient’s best interests. No one should expect you to do anything you don’t feel comfortable doing.

Ratios
Crown-to-filling ratios may sound absurd, but some new dentists have actually been faced with this expectation. If a dentist hasn’t met the adequate ratio, he or she may have been reprimanded or in some instances his or her employment may actually have been at risk. At the end of the day, as a dentist you have gone to school to gain the clinical knowledge to diagnose, educate and treat your patients. Yes, dentistry is a business, but you and your patients determine the best treatment, not the offi ce manager.

Continuing your education
Upon graduation from dental school, you quickly learn that you are a beginner. Is there a treatment you are looking to incorporate into your practice but you feel you don’t have quite enough experience? Take the proper steps to fulfi ll your ethical obligation to do no harm to your patients. Participate in continuing education, specifi cally hands-on CE; engage in a mentorship with a seasoned dentist by shadowing him or her while he or she is doing the procedure; reference online tutorials, textbooks, dental blogs, message boards; and most importantly know your limitations and when to refer to maintain the standard of care and to do what is best for your patient.

“After the physical, emotional and financial sacrifices I’ve made to reach this point in my career, I’ve realized that my dentistry and my work reflect the person I am and how I choose to care for my patients,” said Dr. Ishkanian.

Dr. Ishkanian suggests that if you are faced with an ethical dilemma, address it with the owner or owners of the practice. If you don’t see change on the horizon or there are too many ethical challenges that appear unlikely to be resolved, then it might be time to move on, maintain your ethics and standards and fi nd a practice that shares your philosophy. Always put your patients first, and remember this is your license and your reputation. Don’t put yourself in a position where you’re defending it.

Available ADA resources to help new dentists facing ethical situations include the ADA Code of Ethics, the Ethics Hotline and the archive of ethical scenarios that can be found at ADA.org.

When professional conduct is the question, the ADA Code may have answers.

The ADA Principles of Ethics and Code of Professional Conduct amplifies Dr. Ishkanian’s advice. “The American Dental Association calls upon dentists to follow high ethical standards which have the benefi t of the patient as their primary goal,” says the preamble to the Code.

“The ethical dentist strives to do that which is right and good. The ADA Code is an instrument to help the dentist in this quest.”