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Keeping Patients Healthy and Smiling

Dr. Todd Kaminski : Keeping Patients Healthy and Smiling

May 30, 2006

Dr. Todd Kaminski graduated from Purdue University with a BS degree in Biomedical Engineering in 1982 and went on to receive his Doctorate of Dental Surgery from Indiana University School of Dentistry in 1986. He has been in private practice since then practicing comprehensive, cosmetic and preventive general dentistry. In 1989 he began practicing implant restorative dentistry and was a member of the team that helped Jonathan Davis receive his implants. He is a founding member of Greenfield Central School’s Set A Good Example Foundation and its mentoring program ARROW serving at risk middle school students.

Dental 1: When did you know you first wanted to be a dentist?

Dr. Kaminski: I worked in my father’s dental office when I was 11 or 12 and knew then. I didn’t really make the decision to go into dentistry until I had finished my undergraduate studies.

Dental 1: What attracted you to the field?

Dr. Kaminski: Well I wanted to be able to help people but I didn’t want to make life and death decisions for them. I enjoy doing things with my hands like art and woodworking. Dentistry kind of tied it all in together. And I wanted to be my own boss. I was hoping to be on call less but that hasn’t happened.

Dental 1: What is the biggest challenge right now?

Dr. Kaminski: Maintaining a competent staff that works well together.

Dental 1: What do you think is the biggest change this profession has gone through?

Dr. Kaminski: The biggest change is the availability for doing implants for reconstruction and replacement of teeth. In that line the big change is instead of the surgeon having to choose the placement based on the type and quality of bone, the restorative dentist can now figure out the best place for the teeth and the surgical team can get bone to grow in that spot. That’s probably one of the biggest changes. Some of the materials available have also changed. The use of computer and digital imaging has played a big part. And obviously, dealing with third party payers.

Dental 1: How do you balance the need to stay up to date with the technology while having a full practice?

Dr. Kaminski: It’s difficult at times, particularly when you throw in a family and other community things going on. Basically, I think the best way is working and interacting with peers, reading journals and attending continuing education courses. That’s a blend that works for me.

Dental 1: Do you think our expectations are higher because of all this new technology?

Dr. Kaminski: People have a higher dental I.Q. so they know more of what they want. They are better educated and that’s one of our goals: to educate our patients about their options. It’s no longer routinely assumed that a bad tooth is going to be pulled, or once the tooth is gone that there aren’t many options to replace it. In that regard the standard of care has been elevated.

Dental 1: You were one of the principal players in treating Jonathan Davis. How did you come to meet him?

Dr. Kaminski: Well that’s kind of a neat story. I’ve known Jonathan since he was three years old when he was in the same preschool class as my youngest daughter. I do a lot of programs for preschoolers and their teachers, and their class had a field trip to my office. Jonathan’s mother approached me to let me know about his special condition, Ectodermal Dysplasias, and that he didn’t have any teeth. Jonathan tried to do everything like any other normal kid so his mother asked if I could make him feel comfortable and act like I was counting his teeth like the rest of the kids since that would mean a lot to him. That was how we first met. Then he was a friend of my daughter’s through school for a number of years. When he started pursuing his treatment at my office rather than downtown at the Riley Center, we were able to start connecting things in a more personal way.

Dental 1: How did his treatment plan evolve?

Dr. Kaminski: Through working with Dr. Moenning, we realized there were some deficiencies in Jonathan’s functions and physical situation. So we started looking at the long-range plan rather than just focusing on a day-to-day basis to just make him look acceptable, asking “Where should Jonathan be long term for his health and stability?”

Dental 1: How long has it taken?

Dr. Kaminski: We are about three-quarters finished and it’s been over a three year process. Well, maybe a bit longer when you factor in the transitional dentures, the bone reconstruction and removal of the deteriorating teeth along with the advancement surgery to line his jaws up, stabilize his bone skeletal growth and keep him functioning. Right now we have activated his lower implants but we still have a little bit of time for bone formation on his upper jaw. We should be finished sometime in June.

Dental 1: You used a new kind of implant that heals quickly?

Dr. Kaminski: Yes. The new SLActive implants are restorable in three to four weeks, which is remarkable since it used to be up to six months to heal. There are still some limited applications as far as location and that is why we are delaying the final restoration on Jonathan’s upper teeth because we had to do some bone grafting. The quality of the bone is more compromised in those areas.

Dental 1: Are these new SLActive implants going to change the way implants are done in the future?

Dr. Kaminski: Absolutely. The pace will be accelerated. For most people the biggest drawback is the delay from having the implants to getting a fully restored, functional, aesthetic tooth. I think it will be more appealing to people knowing they don’t have to wear an interim type of denture or partial denture and can have their final product in a shorter period. I definitely feel that is a real plus.

Dental 1: Do you think we are going to see dental implants become the norm, eventually replacing bridges?

Dr. Kaminski: In my practice when a patient is missing a tooth in a certain area then the first choice is a dental implant in most situations. The eliminating factor for most people is the cost and whether their insurance company is going to help cover any expenses.

Dental 1: Jonathan had trouble convincing his insurance company to cover his costs even though his need was obviously medical.

Dr. Kaminski: Correct, he did have trouble.

Dental 1: Is that the norm?

Dr. Kaminski: Well, implants aren’t necessarily cosmetic and it wouldn’t necessarily be elective. It’s just something that insurance companies have not included in their traditional dental plan. In Jonathan’s situation it wasn’t only dental related but also a medical related condition he was born with. You wish the insurance companies could tie it more into the hereditary condition of Ectodermal Dysplasias. That’s where it gets discouraging with third party companies when they are in it for their money and that’s what comes first. Now that implants are becoming more popular I think more pressure will be put on the insurance companies by their paying clientele to start paying for these procedures.

Dental 1: Helping Jonathan touched you on both a professional and personal basis. What’s it been like to be involved?

Dr. Kaminski:
Very rewarding. There was working with Dr. Moenning and having the opportunity to look at different implants, and also be one of the first dental teams in the United States to use the new Straumann implants. Using the SLActive implant was kind of an exciting point in my career.

Dental 1: After knowing Jonathan for many years, what was it like watching him undergo the procedure?

Dr. Kaminski: Jonathan, having the personality that he does, is very tolerant and easy to get along with and he certainly has been a great patient to go through this process with. To get him to this point was a combination of a whole bunch of people having to come together and work together. From Dr. Moenning as the oral surgeon, the family, me as the dentist, my staff coordinating all of the financials, to Straumann and the Ectodermal Dysplasias Foundation, we all had to factor in ways that we could make it work physically, functionally and financially for Jonathan. It’s been great to work with him from that standpoint and to see everyone work together, give a lot and learn a lot. Jonathan has a high tolerance and a really good personality so what might be difficult for another personality to deal with has just been a normal, everyday thing for Jonathan.

Dental 1: Do you think this is going to help his self-confidence?

Dr. Kaminski: Definitely. Just being able to eat differently and not having to worry about his dentures is a big thing. Most of his peers know he had dentures but I’m sure he has been in a compromised situation before where something came loose or popped out unexpectedly. With his new implant he has already had a steak dinner at Oh Charlie’s even without the full activation of his upper dentures. So this will definitely change his self-confidence and self-esteem. We are trying to give him the smile he wants so it looks very natural and feels really good.

Dental 1: Do you normally use this team approach to come up with treatment plans?

Dr. Kaminski: It takes a combination of doctors to work with dental implants. Dr. Moenning is a great surgeon and a great friend. With any implant case, from examining our options to communicating with the patients and doing the implants, working together would be the norm. The general dentist would work with the oral surgeons and the general dentist’s lab technicians to design prosthetic implants to get the results you want. Jonathan’s case was unique because there were so many details involved and much of it had to do with finding creative ways to solve problems and create this opportunity for Jonathan. This was a critical time in his life from both a physical and function standpoint but also from a personal and self-esteem standpoint.

Dental 1: So is it the new technology that is fostering this new team approach to dental care?

Dr. Kaminski: Well that’s particularly true in this case. I think most progressive dentists and healthcare professionals work with a team including physicians and dentists. I look at building the concept of total health dentistry so it’s not just about teeth but it’s about your whole body. There are lots of studies showing the correlation between a healthy body and a healthy mouth.

Dental 1: So this is a more holistic approach.

Dr. Kaminski: Definitely. And that’s a concept that we are striving to develop in our practice.

Dental 1: Would you participate in any more future projects like this one?

Dr. Kaminski: If they present themselves, absolutely. We do a lot reconstruction of accident cases and things like that. They are challenging, rewarding, stimulating and entertaining. So I think there will be more cases in the future.

Dental 1: We have a lot more techniques for cosmetic enhancements. Do you ever find yourself drawing the line with patients over what is needed and what isn’t?

Dr. Kaminski: For me personally some of that line comes from their decisions around finances. My patients tend to be from a suburban area so I have low-income to high-income patients. Sometimes you have to guide people to what is best and some of their options are limited based on their financial situation.

Dental 1: Are dental standards higher these days because of the new technology?

Dr. Kaminski: Society’s idea of what is healthy and acceptable has changed. Even just a few years ago in a denture case I would discourage people from getting too white of teeth because it didn’t look natural but looked fake. But even in the geriatric population I had conceded, particularly with one patient who wanted white, white, white. At first I was hesitant but we made them white, white, white and she thinks she has died and gone to heaven. I think you have to maintain your patient’s expectations but also let them know what is normal and realistic. In my style of dentistry, particularly trying to have a more holistic approach, I wouldn’t say go with straight, white teeth at any cost. I would say like yourself first and if you can add to your smile, that’s a bonus. Rather than getting hung up on “if my smile isn’t perfect then I don’t like myself.”

Dental 1: But you do think a good smile helps people to feel better about themselves?

Dr. Kaminski: Absolutely and that’s really rewarding for me, helping people’s self-esteem change because they like their smile. A smile is what presents itself in conversations and interaction with others. I feel the smile is a valuable part of the personality.

Dental 1: Do you every take it personally when people aren’t happy to be seeing you?

Dr. Kaminski: No. You know 9 out of 10 people come and tell you they hate being here. But for me personally, I deflect that and try to add humor into the appointment. I also accept their stress levels and realize it’s not me they don’t like but the situation. I think what is hardest for most dentists is that we all have a perfectionist personality and accepting that everything isn’t perfect all the time is hard. As well we are usually caring, compassionate and empathetic people so knowing that 90 percent of what we do does inflict some kind of pain or discomfort is hard. As you get more seasoned you still strive for that perfection but you accept there are limitations based on the situation, the patient’s physical shape and your skill level. I deflect all that but it is still stressful. Still there are cases like Jonathan’s that are really rewarding. What was most rewarding for me was seeing how we all came together and looked beyond immediate results to focus on the long range.

Last updated: 30-May-06

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