In this interview, oral maxillofacial surgeon Dr. Douglas DeGroote discusses his path to dentistry, his dental training, procedures and advancements in his specialty, and the changes in dental insurance coverage.
Zarbock: Good morning. My name is Paul Zarbock, a staff member with UNCW's Randall Library. Today is the 27th of April in the year 2005, and I'm in the offices of Doctor Douglas DeGroote, a dentist practicing here in Wilmington, North Carolina, with a very, very specialized practice. Good morning doctor, how are you?
Douglas DeGroote: Good morning, fine.
Zarbock: Tell me what individual, series of individuals or event, or series of events led you to the selection of dentistry as your chosen profession?
Douglas DeGroote: Well I hope I'm not too convoluted here, but it-- I was a computer science major at NC State and uh.. after the second semester where we were taught, it goes by a couple of names, machine language or assembly language where you're using a series of zeros and ones to put programs together, for some reason I was not adept at that. While making an A in Fortran in the semester before, I got a D in that class.
Zarbock: Fortran is?
Douglas DeGroote: Fortran was a language uh.. an old language uh.. computer language that came out that made things very- very simple compared to the assembly language. The assembly language for me was very difficult. And at that point I decided that I was being led into this profession with m- maybe not the best uhm.. skills, and I was gonna be working with these uhm.. machines. And- and at that point I decided that I might want to go to the-- more humanitarian side of things. So I went into the uh.. zoology curriculum at NC State, and that encompassed pre-med, pre- pre dental and uhm.. pre-veterinarian sciences. And uh.. I was working at the time at the pharmacy department at Rex Hospital. Old P- Price was the pharmacist there, and his son was one of the pharmacists. And they had put together a uhm.. a Boosters Club event for the old Carolina Cougar Basketball Team from the ABA, and we were going to fly from Raleigh to Norfolk, Virginia.
Zarbock: The year is?
Douglas DeGroote: 1970, late 1970. And on-- late 1970 or early '71. Basketball season, the ABA professional basketball season. On that- on that trip I met a fellow by the name of Doctor Bud Deebler [Ph?] who practiced in Sanford, North Carolina, he was a- a family dentist. And we had lunch together uh.. there was probably 50 of us in the trip, and it just so happened that I sat next to him at lunch. And he talked about what he did and asked me what I was doing, and- and he said "You know, I think you'd make a good dentist." And uh.. to tell you the truth, I had never really considered dentistry. I was just in the humanitarian health care side of my undergraduate uh.. program and uh.. he said "I know the Dean of Admissions at the University of North Carolina School of Dentistry, Bob Shankel [Ph?]." He said "And I'm gonna call him when I get back home." Am I being too convoluted here? So uh.. he said "You give Bob Shankel's office a call when you get back on- on Monday morning, give me time to talk to him." So I talked to Bob Shankel's office, his secretary, asked that uhm.. I'd like to come and talk to him about possible admission to the School of Dentistry.
Zarbock: What, you're probably a junior or a senior in college?
Douglas DeGroote: Yeah, I was a uh.. that's another story. Uhm.. I had at that time probably about 90 hours, and you- you had to have 96 hours to be considered for admission to the Dental School, that was a minimum. So I went to Doctor Shankel's office and of course he said "We've already got our class pretty much picked for the entering in August of 1971, but uhm.. why don't you get an application off my secretary and fill it out the best you can, and when you get back to NC State and f- send us your- your uhm.. grades and a photo and we'll put it on your admission."
Zarbock: Where is the school by the way?
Douglas DeGroote: Uh.. it's Chapel Hill.
Douglas DeGroote: Uhm.. so I did all that uhm.. and two weeks later I got a letter saying that, "We'd like to interview you for the class of 1971." So I went to the interview, it went very well and I'll never forget uhm.. Cliff Sturteman [Ph?] whose father had founded the school of dentistry, was one of the people that interviewed me. And he- he didn't spend five minutes with me. He said "Come here, I want to show you where you're gonna be in the fall." And he walked me out of his office and down the hallway and showed me the freshman lab. And all the fellows in there in their white coats working over their dentaforms and what-- I didn't know what was going on at that time, but I was- I was really taken back that he said "Come here, I'll show you where you're gonna be in the fall." So I got a letter about three weeks after that saying that "You've been accepted to the class of 1970-- to enter the class of 1975," which would begin in August of '71, it's a four year program, "but you're- you're a few hours short of the 96 hours." So he- so the- the letter said, "You'll have to complete s- uh.. you have to take quantitative analysis," which I did not have, that's a uh.. chemistry class, "and you'll have to get six more hours." So I finished quantitative analysis the first semester of- of uh.. summer session 1971, and then I went to Greensboro to take Health and First Aid, I called them and said, "Would that be fine?" And they said, "Sure, take Health and First Aid." So uh.. in Health I got a B and in First Aid I got a B, and I- I hate to say it on camera, but I probably worked about two hours the whole- the whole time. My finance, Susan, was working in Greensboro- Greensboro at the time, so that's why I ended up in UNCG; I wanted to be around- be with Susan. And uh.. anyway I got my six hours and got in.
Zarbock: You know, older dentists said that part of the application process required them to take a piece of chalk, or a piece of ivory in some cases, and carve a tooth. Was that still the procedure when you entered?
Douglas DeGroote: It was and I must have suppressed that, 'cause that's called the dental aptitude test, and it's a- it's a sort of a nerve-wracking written and a hands-on uhm.. hands-on skills test. And of course, you have to-- there's a spatial analysis part of the written test that you have to go over, but then of course, yes, you have to carve a piece of chalk. And I'm not too sure they do that anymore, I think that's- that was an old...
Zarbock: I've been told in the main that has disappeared from the obligatory part of the enrollment process. But I'm also told that just carving the tooth wasn't one of those "Well it looks pretty good," it had to be with precision.
Douglas DeGroote: Actually, it wasn't a tooth that you carved. It was a geometric figure off a large block of uh.. chalk. And apparently there was no correlation between your success as a dentist in dental school and to how you did on the chalk carving.
Zarbock: Did you enjoy the curriculum, the dental curriculum?
Douglas DeGroote: Well most of it. You know, the- the clinical part was the most uh.. interesting to me obviously. The- the uh.. didactic part was of- often difficult. Uh.. for me, I remember w- going into the finals of our biochemistry exam as a freshman, I had a D average, and I spent about a day and a half going over all the hand-outs, and I went in, I got the second highest grade on the final. And I brought my- so he-- the professor said, "I almost gave you an A, but I just didn't feel like I could." But I- I pulled myself up. But I wasn't a-- if I'd applied myself, I think I could have done much better, but the clinical part I did very well and I enjoyed that, the actual hands-on.
Zarbock: How many students in your class?
Douglas DeGroote: I think we started with 72 and we picked up three from the class ahead of us.
Zarbock: How many women?
Douglas DeGroote: Uh.. there were two women in that class.
Zarbock: That's a change that has taken place since you entered the profession of dentistry.
Douglas DeGroote: Undoubtedly.
Zarbock: Okay. So you're out of dental school, you've got a certificate suitable for framing, and what happened?
Douglas DeGroote: Well, in my sophomore year of dental school, Vietnam was calming down but they were still looking for health professionals, physicians and dentists, to enter the services. And my parents were struggling I think a little bit with my tuition and uh.. instruments and all those things, uh.. the cost of dental school. So I decided I'd apply for a navy Health Profession Scholarship, and I got picked up on that. They paid us $400 a month and picked up our tuition, books, instruments and that sort of thing. And $400 a month back in 1972 is a lot of money. And Susan and I were married uh.. the former Susan Dale McCauley from Versailles, Kentucky, we're married in December of '71, and in '72 $400 was a lot of money to us. And- and with a little bit of a uh.. little bit of other loan that I- loans that I had from the dental school, we- we lived pretty well on that. So when I got out of dental school, I owed the navy three years for- for the three years I was on scholarship.
Zarbock: And how old are you when you graduated from dental school?
Douglas DeGroote: I was 25. So I went to Camp Lejeune for my first tour uh.. my daughter, Jenny, uh.. was born while we were-- she was born in 1974, so we were right between our junior and senior year of dental school. Went to Camp Lejeune out of uh.. dental school as a general dentist uh.. lieutenant in the navy dental corps. Uh.. Geoff, my son, was born there at Camp Lejeune, and then we uh.. were offered a tour in Italy. So Susan and I and Jenny and Geoff packed up-- I should say Susan packed up, she- she did most of all that work. But we packed up and went to Italy for two years. While I was in Italy I applied for-- before we left Camp Lejeune I applied for a regular navy commission. You had to be regular navy to apply to their advanced training programs. So I applied for regular navy and got picked up. And then while we were in Italy, I applied uhm.. for an oral maxillofacial surgery residency at uh.. through the navy.
Zarbock: Where was the residency located?
Douglas DeGroote: Uh.. I went to-- there were f- five naval hospitals that you could be assigned to. I got assigned to the National Naval Medical Center in Bethesda, Maryland. And that's a story behind that in that Norm Luther [Ph?], a great oral surgeon in the navy, sort of took me under his wing at Camp Lejeune and sort of went to bat for me. When my application was the sixth out of the five people chosen to enter the programs in 1980, he went to- apparently went to Washington DC and lobbied the Bureau of Medicine and Surgery folks up there, and wanted me s- wanted to put me not only- not only to be selected, but to put me at Bethesda, which was one of the premier training programs. And whatever he did, whether he put his- his career on the line I don't know, but I owe him a great of uh.. a debt, excuse me, of gratitude, you know, for- for his efforts. Great fellow, Norm Luther, just a-- we used to call him Stormin' Norman, but he was a great surgeon and a fine, fine person.
Zarbock: Where is he now by the way?
Douglas DeGroote: He's retired in Florida.
Zarbock: Do you ever see him?
Douglas DeGroote: No, but I called him four or five years ago, I'm probably due to call him again.
Zarbock: You ought to sent him one of these discs.
Douglas DeGroote: I should, he's uh.. he- he's one of those folks that-- in your- in your career and life that you uh.. look up to and respect, and will never forget.
Zarbock: Well you were in Italy when you were accepted, is that correct?
Douglas DeGroote: Right.
Zarbock: So again, it was packing and moving time.
Douglas DeGroote: Right. Moved back to Bethesda uh.. for- for residency. I took about a month and a half leave and got our feet back on the ground and in the United States of America, it's wonderful to come back to the United States after being out of the country.
Zarbock: Well, you're now in Washington DC and you're going to start your residency.
Douglas DeGroote: Yes, sir.
Zarbock: How were patients located? What was the process for getting patients into your facility?
Douglas DeGroote: Well not only for our specialty, but the whole hospital, the- the naval hospitals were referral centers for the region and- and the world, really. So patients came in- might come from Quantico or they might come from the navy shipyard. And uh.. anywhere in the area, or anywhere in the world.
Zarbock: How would you characterize the type of patients? What were the criteria that established the person being a patient and being referred to the hospital?
Douglas DeGroote: Well most of them were navy and marine cops personnel. Anywhere from needing a tooth out, or some wisdom teeth out, or uh.. trauma patients, or patients that needed orthognathic surgery, that was a large...
Zarbock: I'm sorry, what?
Douglas DeGroote: Orthognathic surgery was a large part of our training. Uh.. orthognathic surgery was moving jawbones around to facilitate uh.. function. Uhm.. overbites, under bites, mal development, that sort of- that sort of thing. We would surgically fracture jaws and move them around and stabilize them; that was a large part of our training in that ... some training programs, trauma was a large part. At Bethesda it wasn't such a large part of our training, although it was a- a- an important part of our training that we got not only at Bethesda, but you rotated through Camp Lejeune for two or three months uh.. in our training. Uh.. Orthognathic surgery, or developing trauma, so to speak, surgically, and- and repositioning jaws was a large part of it. And of course you worked in close uh.. in close professionalism with the orthodontist in those- in- in those cases most of the time.
Zarbock: Tell me about the training. So you walk into the place and you're a naval officer and you're a graduate of dental school, and you're brand new. What do they start off by saying, "This is what you do and this is how you do it"?
Douglas DeGroote: Well uh.. it starts off-- a- at the Bethesda it started off with a two month oral surgery rotation to sort of get your feet on the ground. That's where uh.. where you're doing things that- that you're used to doing, taking out teeth and- and uh.. you know, sort of-- they don't want to start you at the top obviously, like any other profession you have to start at the bottom. So that it's a two- two month rotation on service, and the uh.. senior residents and the chief residents are holding your hand so to speak, and they had wanted you to study extensively before you got there. So I had a good foundation on uh.. on uh.. on physiology, on pharmacology, I had to read Dripps' uh.. Dripps is- is the author's name, Dripps' book on anesthesia. Uhm.. I- I went through uhm.. Guyton's book on physiology before I got there. Uh.. I had read extensively before I got there, which- which they wanted you to do, so I felt pretty good about uhm.. the didactic part of basic medicine, but obviously I had no hands-on experience, and- and the first year or so is really a medical internship, residency, surgical residency, internship sort of thrown in for that first year in that we rotate through uhm.. internal medicine, cardiology, intensive care unit, uh.. plastic surgery, general surgery, uhm.. and I probably left a few out that I'm trying to suppress maybe. Uhm.. but we h- had-- the rotations were with the other specialties in the hospital uh.. where you were a rotating resident. And admitted patients and of course you had mentors with you all the time, uhm.. you weren't on your own. So it's-- for the first year it was- it was-- most of it was out of the oral surgery realm, and then the last two years were spent on service, except for some rotations out of uh.. out of the- of the hospital such as Camp Lejeune for trauma, facial trauma.
Zarbock: Did it fit? You entered this really new realm of professionalism, how comfortable were you with it?
Douglas DeGroote: Well it was fairly stressful. I mean, I- I don't think I'd be telling the truth, i- it was stressful 'cause there were often times you were uh.. you were asked to uh.. present a patient to the staff uh.. physicians. Uhm.. you know? Uh.. like any other uh.. first step out sort of uh.. o- out of the womb so to speak, uh.. i- it's a little stressful, but uhm.. the- the feeling of accomplishment, and- and the joy of moving ahead professionally, you know, suppressed all that, most of the stress. It was- it was not always enjoyable b- enjoyable, but very rewarding.
Zarbock: When you finished your training, what was required of you? Was there a comprehensive paper? Was there a review by your peers? What was the end of the road?
Douglas DeGroote: You could leave training and practice oral maxillofacial surgery. And that- that is still a possibility in this country, you could leave your training program and go put up a shingle so to speak, and practice oral maxillofacial surgery. But I think most people would agree in our profession and really in any health care field, that board certification is the, you know, the epitome of- of your specialty. So while you can spend uh.. two years uhm.. let me back up. You can take the-- back in 1983 I took the writtens for my uh.. American Board of Oral Maxillofacial Surgery certification and passed that. But then you had to- had to wait almost a year and a half to take the orals. And during that time we were gathering cases, and you have to have uh.. a certain number of cases in certain separate fields, submit those certified cases to the board, if they accept those cases then you've passed your written, and you can go before the uh.. the board to take your orals.
Zarbock: Now these are cases whom you have treated.
Douglas DeGroote: Right. Uh-huh. Yes. Trauma, reconstructive, dentoalveolar, uhm.. and pathology I believe were the- were the four sections, but now it's changed dramatically in that there's facial aesthetics and plastic surgical cases that they're- they're teaching now. But I would like to mention one fellow, Doctor Chuck Hutler [Ph?] who was the uh.. program director when I went through training. And he- he's a fellow that uhm.. that- that sticks with me today in that when I get in a bind I always ask myself, "What would Captain Hutler do?" And it- it's gotten me through some tough, tough situations, you know? And I owe- owe him also a debt of gratitude for- for his patience with me, and his uh.. his expertise in his training, and passing that on to me, and I carry some of Chuck Hutler with me to this day.
Zarbock: How would you describe him? A quiet man? Outspoken guy?
Douglas DeGroote: Uh.. very- very conservative. Uh.. not only in his personal life, but his professional life. Uhm.. self-confident, authoritarian. Uhm.. great surgeon, uh.. fearless and yet cautious.
Zarbock: He was a career navy?
Douglas DeGroote: Oh, yes.
Zarbock: Well, you've finished your training, where did you hang up your shingle and what did you do? You stayed in the navy?
Douglas DeGroote: Uh.. I was owed the navy two years from my three years of training, and- and during my training I really thought that I would be in the navy for a career, and uhm.. I had spent uh.. some time on- on a submarine tender in Italy during that tour before I got picked up for training, and really enjoyed that- that sort of sea duty. And I was assigned to the USS Saratoga CV60 out of training; they needed an oral surgeon on the aircraft carriers. So I was assigned to the uh.. Saratoga out of Mayport, Florida in 1983. And I spent 20 almost 24 months on- on her, and during that time uh.. the navy was going through some changes in that they were moving families at the beginning of the fiscal year versus the end of school year, or the beginning of school years. End of school year, excuse me. And there were other things going on uh.. and I really felt with two children and- and uh.. my sweet wife, Susan, that I really kind of wanted to settle down and I was-- and I didn't want to be moved around, and I was at a crossroads. I was at ten years in the service, I had my obligation taken care of for my training, and- and although uh.. I feel uh.. a closeness to the navy and I hated to- to leave all the people that had spent so much time and effort in training me, I really felt that it was best for my family that I got out. So I- I got out and came to Wilmington. Resigned my commission and- and left and came to Wilmington to set up private practice. And joined two other oral surgeons here that had- that uh.. one had been here for quite a few years. I believe Jerry Partrick [Ph?] set up practice in I believe it was '68 and J- and John Caulfield retired out of the army and joined Jerry and they were sort of passively looking for someone else, and I contacted them uh.. heard about them through a friend of mine who was also getting out of the service, he left the air force, and I found out that Jerry and John were looking for someone to join them.
Zarbock: What year did you set up practice here in Wilmington?
Douglas DeGroote: 1985. July of '85.
Zarbock: What does your patient load look like? What kinds of cases, 20% are, 50% are that type of...?
Douglas DeGroote: Well now it's, and this is 2005 and I've been in practice almost 20 years within a few months. Now it's mainly dentoalveolar. That I've sort of honed, shaved some categories off my practice uh.. so I could uhm.. relax a little bit and- and enjoy sort of the fruits of my labor. In a sense that sounds very philosophical, but in a- but it really is a case of self preservation in that dentoalveolar is taking out teeth mainly and maybe putting in some implants and doing some minor pre-prosthetic surgery and- and uhm.. biopsies and- and those sort of things. It- it- I've narrowed the scope of my practice. Uhm.. and I have much more time now to do things that I enjoy doing.
Zarbock: By the way, eventually this tape will be put into hard copy. Would you mind spelling dental...?
Douglas DeGroote: Dentoalveolar?
Douglas DeGroote: D, E, N, T, O, A, L, V, E, O, L, A, R. Dentoalveolar. Meaning basically uh.. the teeth and immediate structures. Oral maxillofacial surgery encompasses not only the teeth and those immediate structures, related structures, but- but the jaws and related structures. Not only function, but aesthetically now. And so if I really wanted to broaden my scope again, I could be doing some facial plastic surgical procedures, rhinoplastys, face lifts, blepharoplastys, uh.. major jaw reconstructions and bone grafts, uhm.. and those sort of things. But the older you- the older I've gotten, the more I- I didn't enjoy the stress of the larger cases and decided that I would, as I said, for prel- self preservation, I would narrow the scope of my practice. So now it's really basically a-- although I have oral maxillofacial surgery on my window out there and my car, really it's an oral surgical practice. Uh.. taking out teeth and wisdom teeth and implants, a few implants when- when I think they've got enough bone, and some other fairly straightforward procedures.
Zarbock: I think it's going to be of considerable interest years from now when other personnel view this tape. Gosh knows what the world will look like then, but right now what is the situation, the wall, the professional wall between what your profession would do with a patient and what a plastic surgeon would do? What do you do that they don't, what do they do, etcetera.
Douglas DeGroote: Oh, you know, there are- there are areas where the professions mingle. Treatment of facial trauma is one, and it's always been a controversial, in a sense controversial uh.. point of contention, but uh.. they do some things very well, but we also do some things very well. And really I think the best results have come wh- in a serious uh.. what we call a face bust uh.. in- in a serious facial trauma, uh.. multiple broken bones, periorbital nose, cheekbones, upper/lower jaws, and frontal sinus, maybe the calvarions involved, a team effort in those big cases, I think the best results come. Because we're the experts on the way the teeth fit together, that leads to foundation. The foundation of the face is really the lower jaw, and if you can establish the lower jaw, the occlusion, the way the teeth come together, then everything else usually starts to fit pretty well. The plastic surgeons are great periorbital surgeons and nasal surgeons, and- and they- they have an expertise there I think that maybe some of us-- I know I don't feel the most comfortable in those areas because of my training. Uhm.. but there are other areas now that- that's blending. Such as I mentioned, face lifts, rhinoplastys, blepharoplastys, some oral surgeons...
Zarbock: What is a blepharoplasty?
Douglas DeGroote: Blepharosplasty? Uh.. redoing the- the uh.. soft tissues around the eyes, the fat pads and the wrinkles and the- and those sort of things. And there are some oral surgeons that are trained in- in their programs, in their uh.. programs to do those sort of procedures.
Zarbock: Where do they learn those procedures, medical school or dental school?
Douglas DeGroote: Oh they l- learn them in their residency, their hospital-based residency training programs, and they'll rotate through different specialties.
Zarbock: And feel a sort of a comfort in focusing on that type of surgery.
Douglas DeGroote: Yep. For sure, they- they ...
Zarbock: What about cleft palate?
Douglas DeGroote: That- that's also a part of oral maxillofacial surgery depending on the training program that- that you're- that you're located, uhm.. or it's also up in the plastic surgical scope of training.
Zarbock: Acknowledging that you are focusing your practice more and more, but let me take you back a little bit. When you were in training, and shortly after training, were there cases in which you thought, "Oh my, I would prefer not to handle this type of case"? In any clinical practice, I think every clinician is drawn positively to certain situations, and removes negatively from others. Was there something that you had at a practice you thought, "Oh gosh. I wish somebody else would be assigned this"?
Douglas DeGroote: Well I think that the- the toughest thing is uhm.. ER call. Emergency department call, it's 2 am and you get a call from the emergency department and there's somebody there, or coming there that has a, you know, major facial injury. And uh.. if- if you're by yourself and you're the first one on-line so to speak, y- you can- you can be right in the midst of a bunch of alligators pretty quick. Because not only are you- you have to worry about their facial injury, but then you have to worry about other organ systems, uh.. obviously cardio vascular and respiratory system. And back when I first came to town, there were nurse anesthetists in the operating room during those cases, and the anesthesiologists weren't around. And I'm not making any sort of judgment on that, I just that the nurse anesthetist and the oral maxillofacial surgeon here are faced with this, you know, face- face crunch, or face bust, or major facial trauma, and you know, it- those sort of cases can- can uh.. make you pretty nervous. Uh.. but it's not- it's not hard to get help. You know, it- it's not hard, and I can- I think I can speak for most- most areas of the country, at least in Wilmington, if you needed some help from the plastic surgeons, or the ENT surgeons were o- often uh.. very willing to help out in those sort of cases. And of course if there's a major multi-system trauma to the patient and the general surgeons are there, they're- they're really the team leader, and uh.. so it's not uh.. I- I hate to project that I'm there alone with a nurse anesthetist and this person is on the brink of- of death, I- I'm not- I'm not s- I'm not trying to project that, but i- initially it can be pretty- it can be pretty uhm.. it can be pretty uhm.. nerve-wracking.
Zarbock: Let's shift to another area of your observation. In the years that you've been practicing, what changes have you noted in anesthetics, for example? What changes have you noticed in equipment? What changes have you noticed in the business of your practice?
Douglas DeGroote: Anesthetics, I think the main thing is uh.. the movement. And when I trained it was uhm.. for what we call an outpatient deep sedation light general anesthetic, taking out some wisdom teeth. The drugs were Valium, Sublimaze and Brevital. Valium was a benzodiazepine, and it's- and- and they're very common today. Xanax, Valium in pill form, uh.. now we- we've moved to Versed, which is a benzodiazepine, but it's water-soluble. Valium used to be-- was- was uhm.. dissolved in, if I'm not mistaken it's propylene glycol, and if you look at what propylene glycol is, it's antifreeze. Now I could be wrong, and I- I'll have to check on that, but it was not water soluble, and there were some dysphoric reactions uh.. with Valium that we don't see with Versed. And I don't think it was the Valium, I think it was the agent it was dissolved in. But it was a great drug, very safe, but now we've got Versed, it's wa- water soluble, quicker acting, shorter acting, and- and more profound a- amnesia. Great sedative drug. Sublimaze is a narcotic, it's still around, and it's, you know, it's still very popular and I- and I've been using it for 25 years. Now Brevital is a- is a uhm.. barbiturate- barbiturate uhm.. and it's- it's a great drug. There've been some manufacturing problems with it the last three or four years, hard to get. Some people went to a new drug called Propofol, very popular right now with- with uh.. a lot of folks both in the office setting and in the hospital. Uh..
Zarbock: Why is it popular?
Douglas DeGroote: Uh.. they claim that uh.. that it has a profound amnestic uhm.. property, and people have almost a euphoria coming out of uh.. Propofol anesthetic. Uh.. there're some prob- can be some problems with blood pressure, especially in the elderly and people on blood pressure medication. I haven't used Propofol, I went to Penethol [Ph?] after Brevital was hard to find because Penethol is another barbiturate and I felt I was staying in the same class, and I really kind of like that, it's- it's a little smoother then Brevital. Uh.. equipment-wise, I would think the major thing is the use of uh.. rigid fixation in facial trauma in an orthognathic cases. Uhm.. metal plates and screws. When I was trained, it was mainly wires. Wires and arch bars. And now it's- it's rigid- rigid plates and ...
Zarbock: What's an arch bar?
Douglas DeGroote: An arch bar is a piece of metal with some lugs on it that go across the gum line of the upper and lower teeth, they're wired around the teeth, and then using the lugs on the arch bar, the teeth can be placed back into occlusion and held firmly while bones heal. So uh.. rigid fixation is- is probably the latest thing.
Zarbock: What's that the advantage of the new equipment?
Douglas DeGroote: Uh.. rigid fixation allows uh.. r- release or no intermaxillary fixation. Release early, or no i- intermaxillary fixation. In other words, the jaws don't necessarily have to be wired together because remember that's how we eat, swallow, speak and breathe, you know, and if- and uh.. if you can eliminate some- some period of having your teeth wired together, patient comfort and- and I'm not too sure safety is an issue. Intermaxillary fixation has been found to be very safe obviously throughout the millennium uh.. for repair of trauma and- and uh.. and orthognathic surgery. But uhm.. but I think that anytime you can add comfort for the patient, being able to move and open their- their jaw is- is of great benefit.
Zarbock: One of the strangest sights I've ever seen was a friend of my younger daughter, and they were children at the time, and this friend who's name is Terry, had a broken jaw and other injuries. Anyway, her jaws were wired together. And she did this scary facial grimace and it turns out she was trying to yawn. Well if you're ever yawned, or tried to yawn with your jaws clamped together it produces a very, very unusual sight.
Douglas DeGroote: Oh, yes.
Zarbock: I thought she was in some sort of distress. So equipment has changed.
Douglas DeGroote: Uh.. besides the rigid fixation, implants have come a long way. We didn't do any implants in training. '80 to '83, at least in the navy program. There were quite a few programs that were teaching implants at that- at that time. Uh.. really, since uh.. about 1985, '86 really, implant uhm.. dentistry has really taken off with the advent of uh.. longer healing phases and uh.. the theory of osteo-integration, letting the bone heal to the implant before it's loaded, uh.. before pressures are placed on the implant, have greatly improved the longevity and prognosis for implants.
Zarbock: Walk me quickly, verbally through the process of implantation.
Douglas DeGroote: Well the simplest would be where the patient has lost a tooth or teeth, and there's enough bone for placement of the implants. Uh.. usually done under intravenous sedation, or a deep sedation like general anesthetic and local anesthesia, Novocain, people call it.. Uh.. their soft tissues are reflected and the bone is prepared with some internally irrigated drills. And then once the bone is drilled then the-- you can-- there are cylinders that you tap to place, implant cylinders that you tap to place. Most of us I think are using screw-type implants where the bone is actually tapped and the implant is screwed into place. And then- and then covered. Some people put them in immediate function. Uhm.. I think most people are still waiting for a period of integration, osteo-integration, and then they're uncovered and loaded with some sort of device to hold a denture or crown and bridge work.
Zarbock: Do you do any of that now?
Douglas DeGroote: Yes. But I'm not doing more extensive uh.. bone grafting procedures. There are some people right here in Wilmington doing some uh.. what are called sinus lifts where the maxillary sinus is the-- excuse me, the floor of the maxillary sinus is elevated, some sort of grafting material placed in the floor of the sinus, and then either at that time, excuse me (coughs). Either at that time, or at some point in the future, four or five or six months later, the implants are placed. Plus, there can be extensive grafting procedure to- grafting procedures to the lower jaw that- that would need to be done prior to the placement of the implants. Uhm.. both of those things have a pretty good success rate. Uh.. they're obviously they're- they're-- it's much more tedious and the potential complications are much higher with- with extensive grafting procedures and sort of pushing the implants to the limits uh.. of their- of their usefulness so to speak, but- but they're-- some are very successful and- and some patients that absolutely can't have or can't wear a prosthesis without the bone grafting and implants, it's of great uh.. benefit to them.
Zarbock: Is there such a thing as patient A donates a tooth to patient B?
Douglas DeGroote: Uh.. no. That's not going on yet. I- I don't...
Zarbock: There'd be organ rejection I would assume.
Douglas DeGroote: Oh yeah, it would be- it would be the old au- you know, autoimmune or-- it's not autoimmune, but it would be the immune system that wouldn't (inaudible).
Zarbock: But could you move teeth around inside of my jaw?
Douglas DeGroote: Right. There's a-- that's called transplantation. Some of those are- are successful.
Douglas DeGroote: Uh-huh.
Zarbock: A low percentage?
Douglas DeGroote: Uh.. I just read an article a few days ago that uhm.. actually I- I believe it's about 50 to 75% are successful, and the success rate goes up if the tooth is not rigidly secured after the transplantation. If it's a little bit-- if there's a little, in layman's terms, play in whatever you use to secure the tooth, if there's a little bit of movement, there's actually those rates go up rather then down.
Zarbock: I wonder what accounts for that.
Douglas DeGroote: You know, the article didn't- didn't say that.
Zarbock: Yeah. It seems paradoxical that if it wiggles, it's going to get better.
Douglas DeGroote: Who knows. I don't.
Zarbock: That's a mystery to which there's a solution 50 years from now. Okay, the business. The practice. How has that changed in your years of being in the profession?
Douglas DeGroote: Well, remember I only got into private practice in 1985, so it's been about 20 years. Back in '85 uh.. there were still some carriers, third party insurance companies that would uh.. would let you take a patient to the operating room and take their wisdom teeth out. That- that-- but that was quickly receding. Uhm.. most people had- had some sort of uh.. coverage for oral surgical procedures back 20 years ago. Uhm.. now the uhm.. carriers are number one, less willing to- to take on uhm.. the oral surgical needs of a group of patients, and the reimbursement rates are- are quite a bit lower then they were 20 years ago. So we found that we're more and more uh.. we've got- gotten off uh.. in other words, we're not a provider for- for many programs now, in that we couldn't be in practice if we accepted the insurance company's rates of reimbursement. Uhm.. back when I first started uh.. Gee, I hate to talk about money, but it is part of- it is part of life, you know, it is part of the American medical uh.. system uhm..
Zarbock: And nobody made you take an oath of poverty.
Douglas DeGroote: True. Uh.. the uh.. I kind of f- lost my train of thought there for a second. Uhm..
Zarbock: Insurance company reimbursements.
Douglas DeGroote: Right. The insurance-- thank you, the insurance company reimbursements are, or have- have fallen quite a bit, that puts the load quite a bit more on- on the patient. Back 20 years ago we would get a uh.. either no co-pay from the patient, or we would get a minimum co-pay because the reimbursement rates were really pretty good that uh.. we didn't need to get uh.. a down payment on the service at the time the service was performed. Uh.. but looking back at the accounts receivables back in- in the old practice, uhm.. it- it got to the point that, you know, we were working uh.. at that point, we'd make, you know, probably uh.. you'd write off a fourth just because you wouldn't get that co-pay. Now we've sort of evolved things and we really are very good about estimating the co-pay and we get that before the uh.. surgery's performed, and then we file the- the uhm.. the rest with the patient's carrier, and most the time we're- we're pretty- pretty accurate with- with that.
Zarbock: What about malpractice suits?
Douglas DeGroote: Another reason that I've s- sort of narrowed my scope now in that my risk uh.. and my risk tolerance, plus my risk- risk exposure is quite a bit less. When you narrow your scope down to dentoalveolar. Uhm.. r- the uh.. the oral maxillofacial uhm.. Oral Maxillofacial Surgery National Insurance Company's who I'm with now. I used to be with St Paul. St Paul dropped us three or four or five, maybe eight or ten years ago, and so the Group of Oral Surgeons now have our own company and- and uh.. it's actually less then is was with- with St Paul. Uhm.. if you do a lot of facial plastic procedures, a lot of orthognathic, you're seeing a lot of trauma or treat cancer patients uh.. for definitive care of their disease, uh.. you could pay a lot more then- then what I pay. But my risk uh.. exposure is pretty- pretty minimal with my type of practice.
Zarbock: But that certainly, I think, has been a change in the practice of dentistry over the years. A number of years ago malpractice insurance, or malpractice legal suits were very, very rare. They're probably not very common now, but they are more prevalent then they were 20, 30, 40 years ago.
Douglas DeGroote: Well, it's a litigious society.
Douglas DeGroote: I mean, look at Wendy's- Wendy's, you know, with that fiasco. You know, somebody thought that they could make an easy dollar. I mean, it's- it's just out there, and it's- and it's a sad commentary on our society.
Zarbock: I know what you're talking about, but years from now, no one will know what you're talking about. Tell us about the Wendy incident.
Douglas DeGroote: Well, Wendy's is a hamburger, you know, a fast food chain, and excellent food, and a lady here a month or so ago uh.. claimed that she found a fingertip in her chili. And uh.. of course she had decided that she was gonna take suit against Wendy's, and- and that on- on this superficial aspect of that, you think "Well, you know, if that's the case, she is gonna make a lot of money with the way things work nowadays." When she thought, "Wendy's has a deep pocket and I'm going after it." As- as it turns out, it was probably and looks like a prefabricated story, where the fingertip came from, nobody knows. But uhm.. but it- but it's just one of those situations where if people think that you- you have some assets and- and you're vulnerable, they'll- they'll go after you for whatever reason.
Zarbock: The woman about whom the doctor is speaking, left the state and is in another state right now and is in jail waiting extradition back to, I believe it's California.
Douglas DeGroote: I believe so.
Zarbock: Anyway, it would appear that it was a florid example of deep pockets. Well, would you recommend your profession to others?
Douglas DeGroote: Well it- it's certainly uh.. a lot of people need- need some help and it's very satisfying to- to be able to offer service. Uhm.. it's- it's stressful in the sense that most of my day is spent being the operator and anesthetist, I deliver drugs to p- keep people comfortable to perform a service, so I have to be ever-vigilant on both the surgical side and the anesthesia side. So if- if you're willing to put up with that, its- it's a great profession. How long we'll be operator/anesthetists it's hard to say. Whether there's some pressure to have a second person in the room to deliver separately the anesthesia, that's in- in some state- state of controversy right now. But uh.. it's a wonderful profession and I- and I- my hat's off to the people that came before me and laid the groundwork and made all those sacrifices and got the education, and reached sort of the outer limits uh.. in- in the realm of ENT and plastics and general surgery and medicine to- to train me and- and my colleagues. And- and I- I owe those folks a lot, and I- and I would hope that I would leave uh.. something to those folks who are coming behind me.
Zarbock: Thank you for making the time Doctor.
Douglas DeGroote: You're welcome.