Combining clinical excellence and compassion
What can you tell us about your background?
I was born and raised in Baltimore, Maryland. I attended college, dental school, and my postgraduate endodontic residency at the University...
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...
Focus on family, patients, friends, growth, and community
What can you tell us about your background?
For as long as I can remember, I wanted to make people smile. I always loved getting the class laughing in grade school. Looking back, I am sure...
Dr. Robert Slosberg facilitates accurate mapping and obturation of the resportive defect with CBCT imaging
AbstractA patient presented with advanced internal root resorption of tooth No. 9. The prominent location of this tooth...
Drs. Brian Shaughnessy, Margaret Jones, Ricardo Caicedo, Joseph Morelli, Stephen Clark, and Ms. Jennifer Osborne review the occurrence of teeth presenting with condensing osteitis and their associated pulpal diagnosis over a 2-year period.
Dr. Andrei Zoryan dispels some of the common myths surrounding carrier-based obturation
Carrier-based gutta percha
Carrier-based obturation (such as Thermafil®, GT® obturator, ProTaper® obturator [Dentsply Tulsa Dental Specialties]) is one...
In part 2 of his series, Dr. Ace Goerig suggests ways to reduce stress in the practice
Almost all endodontists could be completely out of debt and on the way to financial freedom within 5 to 7 years if they only knew the secret. But the secret is...
Dr. Robert Fleisher ruminates on how to prepare for retirement
There are so many articles about everything that you become pretty much overwhelmed and can never expect to read them all. So you pick and choose. You like to learn about the latest and...
Dr. Roger Levin presents the 10 top ways to help create a perfect dental team
With the changes brought on by the economy, top companies are bringing in the best resources they can find to evaluate where their organizations stand. They want to know...
Dr. John West discusses the serendipitous events that helped him to grow into a leader in his field and craft.
What can you tell us about your background?
I was born in London, England, toward the end of World War II, and when I was 3 years old, my parents came to America, “the land of opportunity,” with their brothers and sisters because Europe was pretty much in collapse at that time. That completely changed my life. We settled in Washington State, and I grew up here, and that is why the people and this community are so important to me.I attended the University of Washington School of Dentistry for 4 years and then Boston University (BU) graduate school in Boston, Massachusetts where I was trained in endodontics under (the late) Professor Herbert Schilder.
What made you decide to focus on endodontics?This was a really serendipitous choice. When I was in grade school, I had a hero/mentor named Bill. I was a year younger than Bill, and I still am! I tried to look, walk, and talk like Bill when I was in grade school. He was the patrol boy captain; he ran the projection; he was the president of his class, and the favorite football receiver for Mr. Gidley. I wanted to be just like Bill, so I too became patrol boy captain, president of the class, and ran the projector. He got an A in penmanship from Mrs. Anderson, and so did I. Bill went to University of Washington, and joined the Sigma Nu Fraternity and that’s what I did. Then, Bill applied to dental school, and became a dentist and that’s what I did. And then, Bill became interested in endodontics, and I became an endodontist, and he didn’t.I was thinking of becoming an architect, but all my pals became dentists, and I was apparently a follower or in fear of making my own choices back then, and I applied to dental school too. I was the youngest person in the class, which was a curse and a blessing. I signed up for the U.S. Army early commissioning program, and they promised not to send me to Viet Nam. I requested that they send me to the west coast, so they stationed me in Virginia on the east coast. Again, this was serendipitous. There, I met Dr. David Bryan at Fort Belvoir. He was very focused. He had just graduated from the BU endo program and seemed to truly enjoy and control his technical results. I liked that idea very much. We did restorations for the troops that were going to Viet Nam. The fillings were red, white and blue. That aspect of dentistry didn’t really interest me. In dental school, I worked very hard on the academics, but the clinical and restorative were very easy for me. I enjoyed the fact that endodontics was a challenge. I also enjoyed that in dealing with the anatomy of the root canal system, the result is basically mine—I was accountable for the healing. In other specialties, for example, a periodontist’s success depends on how patients take care of their teeth; for people who make beautiful crowns, their success depends on the lab person. One of the reasons people consider dentistry is because they think they have control—of the days they work, of their staff, of their schedule. In reality, they are not in control because of the variables. In endodontics, you have more control because the number of variables is reduced. So if you are a control freak, which many endodontists are, this is the perfect job.
How long have you been practicing, and what systems do you use?I started my private practice in endodontics in 1975. Along with Drs. Cliff Ruddle and Pierre Machtou, we have created ProTaper®, Calamus® Obturation Systems, and WaveOne®, a single endodontic file system. I think what sets Cliff Ruddle in Santa Barbara, California, Pierre Machtou in Paris and me apart is not that we invented files, instruments and systems—those things simply facilitate the achievement of biologic and clinical principles. The reason that we have been good, sustainable and believable teachers is that we teach a thinking process about diagnosis, treatment planning, and interdisciplinary endodontic treatment. At the end of any teaching session, our goal is to have our colleagues walk away with many biologic and clinical principles and a few instruments and let them decide what is best for their practice. We are constantly improving those systems. In our teachings, we have not just changed doctor’s technique, but we have had the privilege of changing lives. The reason that we designed our “tools” is because we could not do endodontics the way we wanted to because some “tools” that we needed were missing. ProTaper, Calamus Obturation Systems and WaveOne have closed a gap in endodontics. Napoleon Hill in his book Think and Grow Rich, says six magical words, “Find a need and fill it.” We did that, not because of the money, but because our specialty needed these instruments, and I use them every day. If anything was invented that was better than what we invented, I would switch to it immediately.
What training have you undertaken?I have taken a lot of training on the mechanics of endodontics and how to experience endodontics. There is much involved in being successful in this field, and it is not just doing a good root canal. You have to be a superb owner, manager, and business person. You need referrals. Right now, endodontics has lost its swagger. We used to be the king of the hill–everyone wanted to be an endodontist. Now, with implants, less restorative demand, and the economy, restorative dentists are hungry to do more endodontics. Referrals to many, but not all, endodontists are at an all-time low. To be a good endodontist, you need to have an exceptional facility, immaculately clean, state-of-the-art, warm, and organized, with a great team–an administrative and technical staff that frees the endodontist to do what he does best. The staff has to meet, greet and enroll the patient so that you can do the endodontics. You also need to understand efficiency, design the schedule based on energy, and have fees that you are proud of. My 10-year-old niece recently gave me a wonderful quote: “Be your self, because all the other people are already taken.” That really says it all. We all have our individual gifts, and we have to identify our own uniqueness. Also, your endodontic results must be superior and sustainable. If the restorative dentist cannot tell the difference between what you can do and another endodontist’s treatment, you won’t be the first choice for referrals.
How have you arrived at your present philosophy of life?I had late-stage acinic cell carcinoma when I was 26 years old while in graduate school in Boston. Doctors told me that it did not look good. In reflection and context, however, that was a real gift. At the time, I was just going through life. While overcoming this challenge, I have learned that I always have a choice in my experience of the moment, and compared to what I would have been, that has made me very resourceful and present. I love being alive. Out of that experience, I began to read and learn about choices and possibility, and it has been a lifetime evolution for me. If that had not happened, I would not have had this interview now because I wouldn’t have earned it. Cliff, Pierre and I teach; we stand in the other endodontists’ shoes–We have experienced their problems with staff, patients, and referrals. We have cried; we have made mistakes; we have had breakdowns. We have learned to overcome these obstacles and see them, not as problems, but as situations that require smart thinking. We have learned that breakdowns are prerequisites to breakthroughs.
Who has inspired you?My professor, Dr. Herbert Schilder, taught me that endodontics has value, and there is a method to success that is sustainable and reproducible. He taught all of us that endodontics has a 100% capacity for repair. Dr. Cliff Ruddle taught me how to slow down and be meticulous and careful, to do it right. Dr. Gary Carr was my teacher for microscope training, and I admire his extraordinary intelligence. He made me think. Dr. Pierre Machtou is one of the most honest and authentic people I know. He is integrity.
What is the most satisfying aspect of your practice?Successful endodontics is not a mystery. If I just do the biological requirements for treatment success, the probability for success is exceptionally high. As long as I can focus on the outcome I want in spite of pressure to do otherwise, that is very satisfying. In terms of patient experience, patients come to my office in pain and leave in peace. This is a source of joy for me.
What are you most proud of? Personally, I am proud of my marriage of 48 years to my wife, Chris, my health, three remarkable children, and six remarkable grandchildren. I am proud that I am becoming a giver instead of a taker. At this time in my life, I am still growing in that aspect. I am very proud of our endodontic practice, and that I practice with my son Jason, who is truly clinically gifted. Our younger son Jordan joins us in August. It will be a party every day! Our administrative and technical staff is such that if I were stuck in a sinking lifeboat, I would want them with me. We would survive. As a team, there is nothing we cannot do.
What do you think is unique about your practice?All the different types of personalities in this practice are committed to the vision of the success of the patient and the referring doctor. We are a team, and we hire to our uniqueness and our weakness. For example, if one of us is shy, we hire others who love to talk with people.
What is your biggest challenge? My biggest challenge is to delegate and then let go. A lot of times, I will delegate, and then want it done my way. The biggest challenge for the office is referrals. Our practice is growing, and we see this challenge as our biggest opportunity. In 2012, the endodontic practice must be creative to earn referrals. I have discovered that when I change the way I see things, the things I see change.
What would you have become if you had not become a dentist?If we had not left England, I probably would have been a master finish carpenter, like my dad.
What is the future of endodontics and dentistry?The future of dentistry is very bright. People want to look good, feel good, smell good, and appear successful. Teeth are a big part of that. Everyone wants straight, white teeth, thanks to the media. We are at the knee of the exponential growth curve in health and longevity. People are going to live longer because of genetic engineering and robotics. So, people will always need dentistry. Endodontics, on the other hand, may be different. I would not encourage someone to become an endodontist right now. But, looking back, my professor Herbert Schilder in 1973 told our first-year class on the first day of class that we had already missed the golden years of endodontics because of fluoride treatments and the decrease in the DMF (decayed/missing/filled) rate. We were turning to each other and lamenting that we should have become periodontists or orthodontists! But, endodontics has reinvented itself, and thanks to very sophisticated retreatment skills, endodontists are becoming proficient at saving teeth that other dentists can’t or won’t. Endo can have a resurgence. It is easy to just extract a tooth and place an implant, but there are failures in that area too, and they may increase as less competent and less-trained dentists are starting to place implants. If an individual is intentional about success and is willing to learn the paths to success, there will be a job for them forever. The key is, as my 92-year-young dad taught me, “Find a job that you love, and you will never work a day in your life.”What are your tips for maintaining a successful practice?Be clinically superior, get trained, and learn more. Have the best team that you can muster from the town that you live in. Be committed to the success of the patient, not your success. Be accountable—don’t blame circumstances, your staff or the economy. You should think, “The world can be like it is, but within these four walls, I am not going to participate in a recession. That is not what is going to happen here. Here, we perform unmatched endodontics and diagnose what patients need. We teach possibility.”What advice would you give to budding endodontists?Don’t cave in to the fact that things might be a bit slow when you start. Act out of faith, not fear. Fear is debilitating, and faith in energizing, but you have to believe in it. Just believe.What are your hobbies, and what do you do in your spare time?We boat in Canada, snow ski, and golf. I go to the gym now. I hate it, and other gym people tell me that I will soon love it. It has been a few months, and I haven’t loved it yet! I have a great family, and treasure the special moments in our lives. Christmas was too good to be true. We had 50 people at our at our home for dinner, and there was spectacular energy. Everyone was so different and yet so loving. I am grateful for being able to have the privilege of doing something that I never dreamed of–inventing something that is going to positively influence dentistry.
Top Ten List1. A vision statement that everyone has ownership in2. Office building and space that represents us and works3. Practicing, learning, and having fun experiencing our best endodontics with my son Jason4. A team (staff) that values and appreciates us and each other5. Referring doctors who value and appreciate us6. ProTaper, which allows us to easily and efficiently make elegant shapes that are often full of foraminal surprises when packed7. Global surgical microscope with observer scope, which allows us to see the game8. Schilder legacy of endodontic healing potential, technique principles, and a winning thought process9. ASI endodontic carts and Kodak 9000 3D
As the founder and director of the Center for Endodontics, John West, DDS, continues to be recognized as one of the premier educators in clinical and interdisciplinary endodontics. He received his dental degree from the University of Washington in 1971 where he is an affiliate associate professor. He then received his MSD in endodontics at Boston University Henry M. Goldman School of Dental Medicine in 1975 where he is a clinical instructor and has been awarded the Distinguished Alumni Award. Dr. West has presented more than 400 days of continuing education in North America, South America, and Europe while maintaining a private practice in Tacoma, Washington. He coauthored “Obturation of the Radicular Space” with Dr. John Ingle in Ingle’s 1994 and 2002 editions of Endodontics and was senior author of “Cleaning and Shaping the Root Canal System” in Cohen and Burns’ 1994 and 1998 Pathways of the Pulp. He has authored “Endodontic Predictability” in Dr. Michael Cohen’s 2008 Quintessence text Interdisciplinary Treatment Planning: Principles, Design, Implementation as well as Michael Cohen’s soon to be published Quintessence text Interdisciplinary Treatment Planning Volume II: Comprehensive Case Studies. Dr. West’s memberships include: 2009 president and fellow of the American Academy of Esthetic Dentistry and 2010 president of the Academy of Microscope Enhanced Dentistry, the Northwest Network for Dental Excellence, and The International College of Dentists. He is a 2010 consultant for the ADA’s prestigious ADA Board of Trustees where he serves as a consultant to the ADA Council on Dental Practice. Dr. West further serves on the Henry M. Goldman School of Dental Medicine’s Boston University Alumni Board. He is a Thought Leader for Kodak Digital Dental Systems and serves on the editorial advisory boards for: The Journal of Esthetic and Restorative Dentistry, Practical Procedures and Aesthetic Dentistry, and The Journal of Microscope Enhanced Dentistry. He can be reached at: email:
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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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