TALES FROM THE TRENCHES

ISAAC PERLE

DMD, Lakewood, NJ

OWNER, Cambridge Dental Group, Brick, NJ

Years in Field: 43

My Typical Workday

Between my general dentistry patients and my Invisalign patients (which is orthodontics with plastic instead of metal and wires), I treat approximately 40 patients a day. I get to my office right after davening and stay until at least 6:30, or sometimes later. My schedule can get intense, because I put pressure on myself to be on time, but I also like to schmooze with my patients!

I see patients for composite (white) fillings, crown-restoring implants (I don’t place implants in the jaw myself; I leave that to a well-trained periodontist), emergencies, some extractions, and Invisalign patients. I have an endodontist in my office who performs high-quality root canals, and I also have a dental hygienist who cleans teeth and takes X-rays when needed. I go from room to room all day and have learned to use staff efficiently.

At present, I have four treatment rooms (one is for the hygienist) and work with three to four dental assistants. My assistants have extra training and are able to perform some procedures that many dental assistants are not able to do.

I’m also a professor and work at the University of Pennsylvania once a week, supervising third- and fourth-year dental students as they treat patients.

I have been practicing in the Lakewood area since 2015. Before that, I lived in Brookline, Massachusetts for 36 years, where I practiced and also taught at Harvard and had an academic affiliation with Boston University.

How I Chose the Profession

I’d always excelled in the sciences and was also good at sports. I was attracted to dentistry as a way to use my intellectual abilities as well as my good hand-eye coordination to help people. It’s also a very respectable way to make a good parnassah.

How I Chose My Specialty

I’m a general dentist, which allows me to do many things I enjoy in the field without getting bored.

What I Love Most About the Field

Being a dentist isn’t an easy job, but the rewards are great. Aside from the fact that I enjoy helping people, especially when I can relieve their pain, I love interacting with all of my patients. I have the opportunity to meet some very special people from the Lakewood community. Additionally, being a dentist has afforded me the opportunity to found the Jerusalem Dental Center for Children, a nonprofit dental clinic in Yerushalayim.

What I Find Most Challenging About the Field

My biggest challenges have to do with the rigors and responsibility of running a very busy practice. Getting the right personnel and making sure that everything runs smoothly is critical to your success.

Additionally, a doctor has to deal with all types of personalities, and at times that can be very challenging.

I’ll Never Forget When

While working in Boston, I had many interesting patients, including the CFO of a national shoe company, the president of a university, the chairman of a department in one of the major hospitals in Boston, and even an emergency room physician who treated victims of the Boston Marathon bombing.

One of my most memorable patients was a fellow from the United Kingdom who was a minister in Parliament. He had awful teeth and needed an emergency visit on a Sunday. He came in with an entire security detail!

Something I Wish People Knew About Dentists

Dentistry is actually very hard work. It’s not easy working on such small items like teeth and it takes great concentration and skill.

How I’ve Seen the Field Change Over the Years

The field has definitely changed in many ways. When I was in school, all we used in the back of the mouth were silver (amalgam) fillings. Now we always use composite (white) ones. The entire implant industry was in its infancy. It was done very infrequently, more in the context of research, and not routinely. Now, implants are done everywhere.

When I was in school, the University of Pennsylvania’s dental school had the highest percentage of women in the entire country — less than 25%. Today, a majority of dental students — at least 55% — are women!

When I was in school, if you needed a crown, you had to take impressions. Now, you can just scan to get a crown. Dental labs had to use technicians to make every crown by hand. Today, it’s all digital, and you can even purchase a milling machine to make crowns in an hour in your own office.

There’s plenty more, but a comprehensive review of the changes in dentistry today from 43 years ago would be an entire article in itself!

My Advice for People Starting Out

Dentistry takes years of study, but it’s worth it. It’s a great profession, and as I said earlier, rewarding in many ways.

To be a dentist, you have to be comfortable working on small things and in small dark areas. But you must also remember that dentistry is a service-oriented business. Being kind and empathic is very important. If you want to be a good dentist, besides being highly skilled, you also need to genuinely care about your patients. As a dentist, you’ll do fine financially, but you shouldn’t be focused on making money. Think about who you can touch with your skills and compassion. At the end of the day, what you’ll be remembered for is who you helped in your life.

DANIEL FEINER

Ramat Beit Shemesh, Israel

OWNER, Dr. Daniel E. Feiner and Associates

Graduated from: University of Medicine and Dentistry of N.J. with post-graduate training in surgical and general dentistry at the Jacobi Medical Center, Bronx, NY

Years in Field: 15

My Typical Workday

As the sole proprietor of a business, there are two aspects to my job: treating patients and overseeing the business aspects of the office. I see patients four days a week, from 10:30 a.m. to 6:30 p.m., primarily performing implant-related surgery and taking impressions that serve as the basis for creating new sets of prosthetic teeth. Throughout the day, I also have a number of consultation appointments in which I examine patients and formulate individualized treatment plans.

I set aside one day a week to manage the business side of my practice. Having a practice with four dentists, three hygienists, and numerous support staff involves a lot of moving parts that require oversight. Dedicating one day to this weekly allows me the time to conduct staff meetings and meet with vendors. I have a great full-time administrative and business managerial team, but there are still certain responsibilities that I need to oversee myself.

How I Chose the Profession

I was always interested in medicine. It runs in my family; my father is an ophthalmologist. When my sister got married, my new brother-in-law was going into dentistry, and I was intrigued. I did some of my own research; I visited my local dentist and saw that it was a unique profession. It may sound cliché, but dentistry really does combine medicine with art.

When you’re creating a new tooth from scratch, you have to create the most aesthetic-looking tooth for the patient, one that blends into his or her mouth in the most cosmetically pleasing way. This means considering the shape, angle, shade, and form of the rest of the patient’s teeth.

How I Chose My Area of Focus

Originally, I decided not to specialize; I wanted the freedom to perform a wide range of dental procedures. However, over time I found my niche in the implant/surgical field of dentistry. I enjoy the surgical aspects of placing a dental implant and the artistic aspect of placing a beautiful new tooth on top of it. Of course, the best part is giving my patients the amazing gift of a full set of permanent teeth.

What I Love Most About the Field

Beit Shemesh is a centrally located city, and people come here from all over Israel. I feel privileged to meet and treat the whole gamut of Israeli society. My patients come from all parts of the spectrum: Sephardi, Ashkenazi, chassidish, litvish, dati-leumi, etc.

I even treat people from chutz l’Aretz; people travel from all over the world —South Africa, Australia, England, America, Canada, you name it — to come to our clinic.

Aside from those who travel specially to be treated, Jews coming to Israel for a visit will often take advantage of their trip to have their dental work done. Complex dental work can be very expensive, and many patients like to have their treatments done in Israel, where they can get an American-trained dentist and American service at a more reasonable rate.

What I Find Most Challenging about the Field

The biggest challenge, in my opinion, is that while we always want the patient to leave happy, sometimes the patient has certain medical limitations that prevent us from achieving aesthetic perfection. This can be frustrating for the patients, as they don’t always understand why this is the case or why we can’t solve such an issue.

I’ll Never Forget When

One of my favorite stories is the day I treated an admor — one of the big chassidish rebbes. He requested that no office or support staff be present — including my dental assistant.

When I needed assistance, his shamashim happily stepped in to serve as dental assistants — their first and probably last time in this role!

Something I Wish People Knew About Dentists

A huge component of good, quality care is having an amazing support staff (dental assistants, secretaries, business managers, etc.) and good dental labs to work with. This adds tremendously to the success of the clinic and helps obtain optimal results.

How I’ve Seen the Field Change Over the Years

There are always new technologies, equipment and procedures developing in the field, and you have to stay up to date. I place significant emphasis on taking continuous educational courses to keep myself current. Many renowned dentists from all over the world come to Israel to take these courses.

My Advice for People Starting Out

One big lesson that I’ve learned over my 15-plus years in the field is that while we need to put in our hishtadlus, parnassah is truly based on siyata d’Shmaya. It’s a gift from Hashem each and every day.

ARIEL STEINBERGER

West Hempstead, NY

Cosmetic and Restorative Dentist, Smile Creations, Massapequa Park, NY and Quentin Smile Dental, Brooklyn, NY

Graduated from: Touro College of Dental Medicine. Residency in NYU Langone Health

Years in Field: 3

My Typical Workday

At my office, we treat a lot of cosmetic and functional rehabilitations. I’m a restorative dentist, so my typical day centers around diagnosis, treatment, planning, and restoration of patients’ oral health. This generally includes three main areas of work: consultation, treatment, and patient education. I conduct consultations with patients to discuss their dental concerns and treatment options, and perform initial examinations, including X-rays, photos, and impressions, to properly assess and diagnose their oral health.

I develop and execute treatment plans tailored to each patient’s needs, which can include fillings, veneers, crowns, bridges, root canal therapy, orthodontics, and surgery and implants. I’ll often collaborate with other dental specialists to deliver optimal care for our patients.

My duties also include educating patients on proper oral hygiene practices and preventive care and discussing post-treatment care instructions and oral health maintenance.

I wrap up the day by ensuring all patient records are updated and treatments are properly documented.

How I Chose the Profession

The classic answer that dentists like to give is something along the lines of “I enjoy working with my hands, and I see dentistry as a beautiful mix of science and art.” That’s all true, and it’s one of the reasons I love what I do, but it wasn’t the reason I chose my field.

I originally chose dentistry simply because it was in the health field and offered a stable source of income. It wasn’t until I started dental school that I really started to appreciate dentistry as a profession. The truth is, there is only so much you can really understand about any highly specialized field of medicine until you are fully immersed in it.

What I Love Most About the Field

I love that I have the ability to make an immediate positive impact on someone’s life. People come to me for all sorts of reasons — because they’re in pain, or they were born with certain defects or abnormalities, or they were in an accident that affected the way they look, or they’re insecure about their teeth, etc. I feel truly blessed that my job is to build beautiful smiles. It’s a privilege and responsibility that I take very seriously.

What I Find Most Challenging About the Field

Where do I begin?

Let’s start with the precision and detail: Dentists must work in a small, delicate space with great precision. Even a tiny mistake can have significant consequences for a patient’s oral health.

As a general dentist, you’re often expected to perform a wide range of procedures, from routine cleanings to complex surgeries. Each requires a different set of skills and knowledge.

Then there’s patient anxiety: Many people have dental anxiety or fear, which can make procedures more challenging for both the dentist and the patient.

The job is physically demanding. Sitting in certain positions and contorting your body to get a proper view for hours at a time often leads to very serious back and neck issues over the course of your career. (There are ways to address this, such as using high-magnification loupes, designing the workspace with proper ergonomics, and performing stretching and other exercises.)

And lastly there’s the emotional toll. Dealing with patients all day long who are in pain or distress can be emotionally taxing.

I’ll Never Forget When

If you haven’t experienced it, it can be hard to believe the extent to which dental problems can affect one’s life. I meet people whose ability to eat has been hampered due to years of neglect. There are people who are so embarrassed about how their mouths look that they haven’t smiled in years, to the extent that the muscles used to smile don’t work properly anymore.

For some, the solution involves simply fixing one tooth. For others, it requires complex rehabilitation over the course of several years. Both scenarios are incredibly technique-sensitive, incredibly challenging, and incredibly rewarding. One of my most memorable patients was someone I treated when I was in Touro College of Dental Medicine. Back when I was an undergrad at Lander, I had a good relationship with the maintenance man, Alfredo. Alfredo was missing a lot of teeth, which affected his confidence and made him look much older than he was. It was a running joke between us that if I got into dental school, I’d treat him.

Several years later, in my third year of dental school, our brand-new clinic was offering a “friends and family” promotion, and I immediately contacted Alfredo. Not surprisingly, his case was complicated and he needed expensive surgery. I spoke to Dr. Edward Farkas, vice dean of the dental school, and he said they would not only waive the fee, but give Alfredo a special grant for implants to support a fixed prosthesis rather than traditional denture — a procedure that cost tens of thousands of dollars. Alfredo and I were both blown away by the school’s generosity.

I had the privilege of bringing Alfredo to each of his appointments. Together with my amazing faculty, we performed multiple surgeries and designed a set of dentures that improved his appearance and function. Unfortunately, due to Covid, I wasn’t able to see the entirety of his case to completion, but I am grateful and humbled by the opportunity I had to help improve his quality of life.

Something I Wish People Knew About Dentists

I don’t think people realize just how hard our job is. Just imagine performing delicate procedures with sharp objects in a very tightly confined space, on a live, anxious patient… upside down and backward!

How I’ve Seen the Field Change Over the Years

Even in the three years I’ve been practicing, I’ve seen the world of dentistry changing rapidly as it moves into a new digital age. For example, it’s now possible to access excellent, high-level continuing education courses online, from the comfort of your own home — something I’ve found extremely beneficial. (Unfortunately, many of the best courses are given over the weekend, so they’re inaccessible to shomrei Shabbos.)

My Advice for People Starting Out

I’m still in the early part of my career, but I can tell you what’s worked for me so far. Since graduating, I’ve invested very heavily in continuing education. There are so many resources available now to advance in any of the dental specialties. I also believe very strongly in the power of photography. I invested early on in learning how to take proper photos and use them to co-diagnose and educate my patients. I couldn’t practice the way I do without photography.

Dentistry is a highly specialized profession, and in order to succeed, you must be willing to struggle and persevere. In this area of medicine, a millimeter is a mile and the margin for error is very small. It takes thousands of repetitions to become decent at performing any one procedure. You have to be both a perfectionist, and also be okay with things not being perfect the first couple hundred times you do them. It’s a unique and difficult balance.

(Originally featured in Mishpacha, Issue 981)