What can you tell us about your background?I grew up in southern Orange County and earned a bachelor’s degree in biology at San Diego State University in 1983. There I met my future wife, Kim, at the...
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Dr. Robert Slosberg facilitates accurate mapping and obturation of the resportive defect with CBCT imaging
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Practice Profile | Dr. Anthony Horalek: The art and science of endodontics
I started out life with humble beginnings in the state of Nebraska. I grew up on farms, in small towns, and in Lincoln, Nebraska. I was in foster homes from the age of 4 to age 12, when I was adopted and my name changed to Anthony L. Horalek.
I attended high school in Palmyra, Nebraska. There were only 29 students in my graduating class. I made the best of it by signing up for the most challenging classes in science, math, art, and business. I was in drama, on the speech team, and I lettered in track and field.
My adopted father passed away when I was 16 years old. A little over a year later, my adopted mother and new stepfather decided to move to Oregon. I asked to finish high school at Palmyra, Nebraska and finished out my senior year by delivering newspapers and finding odd jobs to pay my bills, so I’ve been on my own since I was 17 years old.
I wasn’t sure what I wanted to do after I graduated high school, so I decided I would enlist in the military. I signed up to start basic training 6 months after high school graduation. My high school guidance counselor advised me to try one semester of college at Peru State College prior to my enlistment date. I focused on art and biology. I was surprised when I was called for an impromptu meeting with the dean of student affairs, former head football coach and athletic director, Jerry Joy, who advised me to stay in college rather than enlist, so I did.
I then transferred to the Kansas City Art Institute (KCAI) on a full-tuition scholarship with only the shirt on my back. I did well; however I met a dentist while working off-campus. He was impressed with my artistic ability and told me that I would make a great dentist. I took some career testing at Rockhurst University in Kansas City and discovered that dentistry might be a better fit for me. I then switched my focus to dentistry and went to study at the University of Nebraska.
I applied for and received Reserve Officer Training Corps (ROTC), Health Professions Scholarship Program (HPSP) scholarships. After 4 years on active duty, I applied and was selected for endodontic training in the United States Army. This paid for most of my college education. I accumulated a 10-year active duty obligation, which gave me the opportunity to serve with some of America’s finest soldiers, live over-seas, and learn more about how our government operates. I was a full-time training developer and instructor for 2 years, as well as an executive officer for a 350-man training company at the Joint Special Operations Medical Training Center (under the auspices of the Special Warfare Medical Group), Fort Bragg, North Carolina. I also taught an introductory biology course for Campbell University during this time. My last duty assignment was in Germany, where I was assigned to Heidelberg Dental Activity (DENTAC) as an endodontist.
I decided to make my home in Raleigh, North Carolina, where I have lived and practiced endodontics for the past 7 years.
Is your practice limited to endodontics?
My practice, North Raleigh Endodontics, is limited in its scope, based on my training, experience, abilities, and in-accordance with state law. As dental specialists, I believe we should narrow our scope to match our training and expertise. The breadth of this scope and the language that defines endodontics as a specialty is debatable, and these will also change over time.
Why did you decide to focus on endodontics?
I’ve always been a curious person and fascinated about what happens “inside” of things. So I was always curious about the inside of teeth. I pondered prosthodontics and endodontics. I’ve always been interested in what can be termed precision science and precision arts. I think endodontics has some characteristics of a precision science and of a precision art.
How long have you been practicing, and what systems do you use?
I’ve been practicing dentistry since 1995 or the past 18 years. I was a general dentist for 5 years, and I’ve been an endodontist (residency included) for the past 13 years.
I use The Digital Office (TDO) software, Carestream 3-D imaging (Carestream 9000 3D), Carestream 6100 radiographic sensors, and Ultradent Products, Inc., as some of my favorite products and systems.
What training have you undertaken?
I attended the Kansas City Art Institute as an illustrator in-training for 1 year, but my study in this area started in junior high school, when I started teaching myself how to draw.
My formalized dental training after dental school was an Advanced Education in General Dentistry (AEGD) with the U.S. Army at Fort Lewis, Washington. After endodontic residency at Virginia Commonwealth University (VCU) School of Dentistry, I took 3 years of continuing education on dental implants. I continue to study implants, although it is not the core of my practice.
My military training consisted of Reserve Officer Training Corps (ROTC) and other courses related to military service. A few courses were cadet Basic Camp, Advanced Camp, the U.S. Army Airborne Course, the US Army Jumpmaster Course, the Combat Care and Casualty Course (C4), the Advanced Trauma Life Support (ATLS) Course, the Expert Field Medical Badge (EFMB), the Instructors’ Training Course, the Training Developers’ Course, and the Collateral Duty Safety Officers’ (CDSO) Course. Suffice it to say these short training courses of 2 to 8 weeks in duration each, have also influenced how I think and work today.
Who has inspired you?
In chronological order, the following people have inspired me: James and Alycemae Archer (Lincoln, Nebraska), Dr. Ken Anderson (art professor, Peru State College, Nebraska), Jerry Joy (former college football coach and dean, Peru State College, Nebraska), Jack Lew (illustrator professor, Kansas City Art Institute, Missouri), Jay and Jary Johnson (Des Moines, Iowa), Dr. Sreenivas Koka (UNMC School of Dentistry, Nebraska), Dr. Gary Carr (San Diego, California), Dr. John Khademi (Durango, Colorado), Dr. Joey Dovgan (Phoenix, Arizona), Dr. Jeff Janian (UCSF School of Dentistry, California), Dr. David Sarrett (dean of students, VCU School of Dentistry, Virginia), Dr. Fred Liewehr (U.S. Army Endodontic Program Director/VCU School of Dentistry, Department of Endodontics, Virginia), Dr. Marga Ree (private practice, the Netherlands), Dr. Marc Balson (Phoenix, Arizona), and Dr. Rick Schwartz (San Antonio, Texas), and Dr. Nicholas Pediaditakis, (Raleigh, North Carolina). Each of these people has given me something that I try to emulate today, and I am grateful.
What is the most satisfying aspect of your practice?
This might sound trite, but the most satisfying aspect of my practice is being able to help patients with complex dental problems. I do this by integrating each patient’s endodontic diagnosis and treatment with his / her comprehensive treatment.
My professional development has been greatly enhanced by participating in forums that are part of our practice management software. By viewing and exchanging opinions on 20-30 cases per day from top clinicians, as well as posting my own cases for comments, I have found that my development as a clinician has been helped immeasurably. Being part of a community with a shared vision has helped me refine my understanding of what the standards are and enabled me to improve my skills and understanding both in clinical and practice management matters.
Professionally, what are you most proud of?
I’d have to say I am most proud of a goal I set when I was in dental school. I set a goal as a freshman that I would achieve straight A’s throughout dental school. I fell slightly short and received a 3.98 grade point average. As a result of that goal, I was the first student in the 100-year history of the University of Nebraska Medical Center (UNMC) College of Dentistry to graduate With Highest Distinction. I had not planned for that; it just happened as a product of the other goal. I felt like I had established excellence in something for the first time.
I look at grades, credentials, and degrees differently today than I did then. I am now more interested in learning than “getting the grade,” as these are often two different things. The way in which we measure grades may or may not be a reflection of learning and understanding.
What do you think is unique about your practice?
I make an illustration for every patient and write out my findings and the patient’s treatment options on the illustration. I give that drawing and treatment plan (a visual algorithm) to the patient as a gift after an assistant scans it into our practice management software. I can do this in less than 2 minutes. It seems to amaze patients and referring doctors alike, but it comes naturally to me. It also helps the referring doctors understand what is going on with their referred patient because the illustration is included in my reports back to the referring offices. The illustration also helps me understand what happened long after I saw the patient, without having to search through several pages of treatment notes and documentation. The illustration also serves as part of the informed consent to the patient for the treatment that I provide or do not provide.
What has been your biggest challenge?
My biggest challenge in life has been finding direction. Picking the right direction or goal is just as important, if not more important, than achieving an established goal to me. I believe that selecting and achieving the most optimal goals helps one achieve his or her potential. We only have so much time and energy, so it is imperative to set goals wisely.
My biggest challenge in endodontic practice was becoming established the first 2 years after the practice opened. I started the practice from scratch, right after I exited the military. I made many mistakes the first 2 years. I am a fast learner though, and I have always been attracted to outstanding mentors. I continue to study what traits and qualities of my mentors that have made each one successful. I try to adapt those traits and principles to me and into my practice. This has helped me become successful.
What would you have become if you had not become a dentist?
I would have become an illustrator or a designer. I may still become these things if I am able to. As a child, I wanted to become a police officer.
What is the future of dentistry and endodontics?
I have not thought about the future of dentistry profoundly, but I am concerned about the many new dental schools cropping up in the United States, without rigorous study on “needs assessment” of the number of dentists needed to serve our population. Are the dental schools opening because there is an underserved population that has a need? Or are they opening as a revenue source for universities? This issue requires more study.
Corporate dentistry (without dentist ownership), is also a hot topic presently. I think non-dentist owned corporations have the potential to harm the entire profession if put into the wrong hands. Corporate dentistry without dentist ownership puts the control of practices in the hands of business men, investors, or corporate boards that know very little about the profession of dentistry, other than it has a high margin for potential profit. There is a great danger here that profit-motive could take over dentistry completely if not regulated by dental professionals. I understand there are two sides to this issue, and that not all non-dentist controlled, corporately-owned dental offices are practicing badly, and some serve underserved sectors of the public. It will be interesting to see how this plays out.
Another troubling concern is the possibility that the excessive numbers of dentists that will likely be produced by these extra universities could feed into the (non-dentist owned) corporate dentistry business models. This could result in strengthening these types of entities, to the point that our present model of private practice, as we know it, will be snuffed out. Dentists could be nothing more than employees whose treatment decisions are largely determined by business models and insurance policy-driven algorithms.
One of my mentors predicts that dental offices might gravitate toward two different directions: 1) the elite fee-for-service boutique practice, where the patient seeks out the best possible treatment, even if it is more costly, or 2) the corporately controlled, HMO, PPO, insurance-driven, mega-practice.
I think endodontics has a bright immediate future, but there is great room for improvement. Cultural problems exist within our specialty that includes some of our colleagues prioritizing financial (money) and personal dominion (power) over professional service. While this is endemic to humankind, it is clear to me and others that this culture, taken to the extreme, has negatively impacted the quality and outcomes of endodontic treatment provided in the United States.
There’s a lie that says something like this: “The more money I make in practice, the better doctor I am.” This is nonsense. Unfortunately, this is a philosophy that is prevalent within the minds of many dentists in the U.S. today. This has led to the “churn-and-burn” endodontic practice model, where endodontists and dentists complete all treatments (to include complex molars and premolars) in 45-60 minute treatment sessions. I fear this practice model is driven by a for-profit-only motive, not by a professional-service motive. As a past president of the American Association of Endodontists, Dr. Marc Balson, once exclaimed, “We have met the enemy, and it is us!”
Many patients have been damaged by this philosophy, and our reputation as endodontists has been damaged amongst our sister specialties and referring doctors. I strongly believe it is a hoax to believe that we can treat all patients like this and achieve favorable patient-centered outcomes, which should be our top priority as clinicians.
Disease-centered and process-centered outcomes are still important, as well. Putting these outcomes first is what will differentiate us as endodontic specialists and set the example for our general dentist colleagues.
On a very positive note, our specialty has a lot of extremely bright and talented people that can help us navigate through these problems. With hard work, integrity, forward-looking plans, and the right leaders, the endodontic specialty will morph scientifically, biologically, clinically, and politically into a specialty that will remain viable and successful. There will be no status quo.
What are your top tips for maintaining a successful practice?
What advice would you give to budding endodontists?
Find your talent, and do it better than anyone else.
Work hard, work smart, and put your heart into it.
What are your hobbies, and what do you do in your spare time?
I like to cycle, travel, and draw. I like to travel a lot on weekends. I like to read and think profoundly about things.
Top ten favorites
10) “Super Rick” Schwartz and his relentless work ethic. The man is an animal!
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Research has shown that irrigants are more effective when they are electro-mechanically activated.
Research has shown that irrigants are more effective when they are electro-mechanically activated.
Acoustic streaming and cavitation have been proven to significantly enhance cleaning of difficult anatomy. Studies have shown that low frequency (Sonic) oscillation (160-190Hz) was not sufficient to create acoustic streaming or cavitation within the canal space.
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