Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice
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Focus on patients, family, academics, and endodontics
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Rich Mounce is a full time Endodontist in Vancouver Washington, USA. He graduated from Northwestern University Dental School in 1985 and the Oregon Health Sciences University Endodontic Residency Program in 1991. In addition to his private practice, he is a highly sought after international speaker, making well over 50 presentations and hands on courses in 2008 alone. He has lectured in dozens of countries as diverse as Cambodia and Bulgaria and at major meetings globally. In trade magazines, he is the most widely published endodontic writer worldwide writing the equivalence of 6 features a month. Endodontic Practice USA caught up with Dr. Mounce at his home in Vancouver and asked if he would take a few questions. His answers are enlightening, honest, and at times humorous and show a down to earth humility those who know him say is his hallmark.
1. What technology do you use? Why?
At the end of the day, it’s always the clinician, never the equipment that provides a great result. That said, today’s technology, methods and materials are almost unrecognizable from where we were as a specialty when I graduated from my residency in 1991. In that era, there were no microscopes (Global Surgical, St. Louis MO, USA), no bonded obturation (RealSeal*), no rotary nickel titanium instruments (Twisted Files*), no widespread use of digital radiography (DEXIS, DEXIS Digital Radiography, Alpharetta, GA, USA) and we had one irrigant in popular use (now we have chlorhexidine and liquid EDTA-SmearClear*). Now we can even bond carrier based obturation materials (RealSeal One Bonded Obturators*). I use the new technologies noted above routinely.
These technologies are a quantum leap forward from the past. For example, with the Twisted File, for almost any tooth, the entire preparation can be made with one or two files. The reduction of microleakage based on the literature using bonded obturation materials versus gutta percha is stunning. We’ve come a long way in the right direction as a specialty. I am proud to have a small role in teaching these advances.
2. What is the most satisfying aspect of your professional work?
On the clinical side of private practice, I enjoy the single-minded focus needed to treat patients. I am proud of my key staff person, Dennis Ghormley has been with me for years now and I could not ask for more loyalty or effort.
On the personal side of private practice, I’ve met some special people. A few were famous, but the truly special ones have been ordinary people who had a story and cared enough to share it with me. There is not price you can put on that.
Writing and speaking are alien worlds compared to clinical practice. Both require skills sets that are unique and separate from the office. You can’t hide when you write and speak. While clinicians can have disagreements over details, the basic principles and knowledge must be there and I must be current on the latest literature. I meet many sharp clinicians on the road who know the literature. As a speaker I have to assume that someone in the room is smarter and/or knows their literature better than I do. It’s a good way to stay current and improve your knowledge base.
I really get a buzz seeing an audience enjoy a lecture. It is a challenge to win audiences over, hold their attention, teach, and if possible, make them laugh. This can be a tall order, especially if a lecture is translated in a foreign country. International lecture travel has an ambassadorial component, both for oneself, for the trip sponsors (whoever they might be) and for America. It is vitally important to be respectful, listen when possible and be connected to the audience by knowing something about them and their needs before speaking and then giving it to them.
Writing is a different beast all together. I get e-mails from all over the world almost on a daily basis. People read an article and write with questions, perhaps to disagree or to say “Amen.”
Writing comes naturally to me and articles tend to write themselves. Writing provides a format that allows me to think through diagnoses and clinical treatments in fine detail and then commit them to paper in a way that others, especially general dentists, can learn from my experience.
3. What has been your biggest professional challenge?
Having enough time to do everything to the standard that I expect of myself. It’s a tall order for any person (especially a professional) to keep their faith, family lives, marriage, physical health, practice and hobbies in balance. It could be easy to stagnate in some area of my life. I take intentional steps to keep my life in proportion. I never waste time. For example, I work relentlessly on planes and waiting for flights. While that may not sound terribly spontaneous or romantic, being organized and using time well allows me to have the time to put my wife Laura first where she belongs. It’s an essential skill for the professional whether you have a public profile or not. All of this notwithstanding, I’ve been to some remote places for extended periods of time with my shorts, sandals, scuba gear and without my laptop or anything dental. Its not all go, go, go.
4. What are your suggestions for maintaining a successful specialty endodontic practice?
Due to the sagging economy, increased ratios of specialists to general dentists in many metro areas, improvement in materials and methods (leading to many general dentists doing more of their own endodontics), the rise of implants and a host of secondary factors, building relationship with patients and referring doctors has never had a greater value, either monetarily or more importantly in human terms. In part, relationship can be built through strong communication verbally and in writing (the office forms). Superlative marketing is to give the best care possible, i.e. valuing the person and the result over speed. Said differently, all of ones misdeeds come back to haunt them while the good moves all build to create more success and satisfaction.
In the long term, I predict more endodontists will place implants, more will be certified to provide IV sedation, lasers and cone beam technology will become common in endodontic offices. Early adapters to this new technology and these skills will reap the benefits. The days of “reamin’ and dreamin’” with routine endodontic cases being referred is coming to an end. For the specialist, going forward, its primarily going to be the most difficult cases that are referred. Technology has put many cases well within the reach of general practitioners, especially those with a microscope. To their credit, many general dentists are adapting this new technology and are doing beautiful root canals with it, cool.
5. What advice would you give to general dentists who want to become endodontists?
A s A small book could be written on this subject and much depends on ones grades. Where it gets tricky is the applicant that is on the bubble, decent grades, but not an automatic admission. I’ve had a number of dentists ask me this question that fit into this category of applicant and want help. For these individuals, my best suggestions are to:
· Write an article.
· Watch as many different endodontists as you can.
· Take every endodontic class possible.
· Read every article in the Roots Journal, the JOE and IEJ as well as EP USA!
· Practice on as many extracted teeth as you can find.
· Observe at different endodontic graduate programs if possible.
· Do some kind of endodontic research if you have the opportunity.
· Introduce yourself to as many program chairmen as will meet you, have questions ready, listen carefully to the answers.
And while a list of such suggestions can go on indefinitely, at the top of the list, be sure that being an endodontist is your life’s passion.
6. When did you decide to become a specialist and why?
I had ten thumbs as a general dentist. It did not come naturally to me. Three years after dental school graduation, I went to watch my local endodontist. I had a simultaneous revelation and epiphany! He was fast, efficient, made it look easy, the results were excellent and the patient got up from the chair with a smile. I went back to my office, did what he did and it worked beyond my wildest expectations. I applied to the endodontic program at the University of Oregon in 1988, got accepted and here we are.
7. In the dental world, whom do you most admire?
Dr. F. James Marshall was the chairman in my endodontic residency program. He passed away in January 2008. We wont see a man like that again anytime soon. He was an honest and direct guy and he allowed you to be forthright in return. I never sensed judgment from him, no attitude. He was open to different viewpoints and not dogmatic in his teaching. He could look below the surface to see what others might have missed about someone. After he retired, we had a number of meals and had long discussions and debates that were enlightening and often humorous on a wide range of subjects, far removed from endodontics. When we would part he always said “Skate with your head up and stay out of the corner with the big boys” This takes a little bit of context, but I always took it to mean do your best, be careful, but stay in the game and don’t quit trying. If I had a second dad, it was he. He made a massive difference in my life for which I am grateful.
8. What is the future of Endodontics and Dentistry?
My crystal ball says that there will be sweeping changes in the delivery of dental care over the next two decades. The general practice as we know it now will eventually die out. We will have either specialized (the specialties as we know them now or doctors just dedicated to esthetics, implants, etc) single doctor practices and/or much more group practice due to the economy of scale. Practice standards will demand that clinicians work together far more cooperatively that we have in the past. In essence, there will likely be more big groups where there will be specialty staffs working with general dentists under the same roof with collective ownership.
Technology is reaching a critical mass where a general dentist cannot be reasonably expected to have all the equipment and skills needed across such a wide range of procedures. It will make much more sense from every perspective to have pods of doctors working together where the comprehensive care of the patient is a primary value. In such a model, a professional human resources staff and non-dentist management handles all the non-clinical functions.
The future of endodontics is bright at all levels. General dentists will be able to treat cases more safely with every improvement in shaping instruments and obturation methods such as those detailed above (RealSeal and The Twisted File*). Each of these advancements raises the bar on the standard of care and makes the option of natural tooth retention more favorable than implants where the two are side-by-side options. The endodontist, who is a skilled endodontic surgeon, can give IV sedation and places implants will be busy into the foreseeable future.
9. What are your passions and what do you do in your spare time?
My wife Laura is my overriding passion. Family comes first. I travel a fair bit lecturing so I love coming come.
Outside of the house, technical scuba diving in caves is a passion of mine. There is an absolutely magnificent world in the caves that few people have or will ever see. For me, the most beautiful places in God’s creation are in the Bahamas in caves. The training, gear, practice and hassle of diving in these blue hole “bush” caves (they are relatively isolated in the wilderness) is extensive, but if you envision the Taj Mahal, The Golden Gate, The Pyramids, etc all put together, for me, they would not match the crystal formations that are in these caves. There is nothing else like it on earth, a surreal landscape of unparalleled natural beauty (http://www.bahamasunderground.com/).
10. What is something that only your best friends would know about you?
My faith guides my life.
I love to play cribbage and go for long drives with my wife. For us, it’s a chance to catch up on the state of the world. I enjoy cooking, reading and working out almost every day. I enjoy a respectful political debate and also listening to someone speaking about something I know nothing about. I learn more that way.
I am passionate about Manchester United Football Club and Real Madrid. My weekends are brighter or cloudier depending on whether my teams win or lose.
I am also writing a book at the present time that has nothing to do with dentistry. It is a collection of essays and stories that collectively were written over the past few years. One of the stories that it details is my experience getting “dead stuck” in one of the caves that I mentioned in the last question. I was pinned at 123 feet of depth by cave walls and couldn’t move. It’s a funny story, funny now that I am safely above ground. I’ve also detailed some of the more amusing details of my travel as captured in e-mails. It also has a Christmas letter I wrote to my daughters about life, love and the pursuit of happiness. It should be interesting!
Thanks for asking the questions and having me do this. All the best to EP USA!
*SybronEndo, Orange, CA, USA
Dr. Mounce offers intensive customized endodontic single day training programs in his office for groups of 1-2 doctors. For information, contact Dennis at 360-891-9111 or write
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There remains a growing belief among clinicians that obturation is to blame for endodontic failures. This notion has more recently fallen under scrutiny as researchers have discovered that the most thorough obturation can only reflect the quality of the cleaning and shaping of the canal. In fact, a number of researchers point to the thorough use of irrigants — making sure that the debris and irrigant itself are lifted completely out of the canal, not forced out the apex — as the most important determinant in the long-term success of an endodontic procedure.
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