Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice
What can you tell us about your background?
I was born and raised in Seattle, Washington, and lived there until I was 13 years old. My family relocated...
Focus on patients, family, academics, and endodontics
What can you tell us about your background?
I have a bachelor’s degree in chemistry with a minor in business. I was accepted off of the alternate list for dental school and then attained...
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Military endodontist Garth Hatch explains why he enjoys helping others
Can you tell me about your background?
I was born and raised in Riverside California. I am the forth of six children and lived in the same house until I left for college. There were often space issues with this many children in the house, but one of the benefits of having lots of siblings (2 brothers and 3 sisters) is that there was always someone at home to do things with and my family became my best friends.
My Dad was a firefighter and my Mom stayed at home for most of my growing years. Money was usually tight growing up, but there was plenty of love and friendship. After high school, I went to college at Brigham Young University and ended up changing my major a few times. I debated becoming a firefighter like my Dad, then switched to physical therapy and finally decided to apply for dental school between my junior and senior year in college. Unlike many of my friends in dental school, I didn’t really know too many dentists personally and learned about many of the benefits of the profession from a friend who was applying for dental school. It was a whirlwind change of plans and I ended up taking the DAT, applying for dental school and was accepted at Indiana University School of Dentistry all within a 6 month period. My wife was from Indiana and IUSD was a great school for me both personally and professionally. I feel that God was directing my path because it was a big change in my career plans, yet it was one of the best decisions I’ve made.
When did you decide to become an Endodontist?
During my second year in dental school, I had a great Endodontics course taught by Dr. Joseph Legan. Dr. Legan was a terrific professor with a real passion for Endodontics. Even though the course was challenging, I really enjoyed both the clinical and didactic aspect of endodontics. We began training in rotary instrumentation that year even though it wasn’t commonly being taught at many dental schools during that time. I decided during my sophomore year that I wanted to become an endodontist. It was also a wake up call for me to keep my grades up when I realized how competitive it was to be accepted into an endodontic residency. At least five of my classmates also ended up specializing in endodontics and I think a big reason for that was because of Dr. Legan.
Can you tell me more about the training you have undertaken?
After graduation from dental school in 2003, I went on active duty in the US Army Dental Corps and completed a one year Advanced Education in General Dentistry at Fort Jackson, South Carolina. It was an amazing training program with a lot of one on one instruction from specialists in most of the dental specialties. In 2005, I began my Endodontics Residency at the US Army program at Fort Gordon, Georgia. It was a good residency program directed by Dr. Anthony Joyce, Steve Roberts and Stephanie Sidow. We also trained frequently with the Endodontic Department at the Medical College of Georgia School of Dentistry in Augusta, Georgia.
Throughout my dental career in the military, I have also been blessed by several informal mentors who willingly shared their wisdom in various aspects of dentistry. One such mentor is a periodontist named Dr. Michael Dinos, who is an excellent surgeon and implantologist. Through both shadowing and hands on placement of dental implants with Dr. Dinos, I have been able to see the many benefits of this treatment for a wide variety of patients. This experience has also strengthened my surgical skills in performing surgical endodontic procedures.
At what point in your career did you join the armed forces?
After I applied to dental school, I began looking at various options to pay for my dental education. My father-in-law, a career Army officer encouraged me to look into various military scholarship options available to pay for professional education programs. I decided to apply and was accepted into the US Army Health Professions Scholarship program. This paid for all four years of my tuition, books and school related fees while attending dental school as well as a monthly stipend.
What helped you decide to choose the military? Are you happy with your choice?
The financial assistance I received during my dental education was obviously a major factor in joining the military. The military scholarship allowed me to focus on my education without having to stress about student loans. There have also been several other advantages to practicing in the military including the opportunity to travel, interaction with other terrific professionals and advanced dental education.
As with any career choice, there are advantages and disadvantages to practicing in the military, yet I’ve been very happy with my choice. If I were to do it all over again, I would still choose to join the military when I consider the opportunities I’ve had and quality of life I’ve experienced. It really has been a fun ride.
In your clinic do you perform solely Endodontics or do you practice other types of dentistry?
At present, I am the only endodontist at our dental clinic that provides dental care for a large soldier population as well as dependants for the Baumholder military community. We also receive referrals from several other outlying dental clinics in Germany and Belgium. With that said, I’m usually fairly busy performing my specialty of endodontics. My practice is unique in that we occasionally will perform dental exams for large groups of soldiers as our mission requires as well as perform other military related training throughout the year. On average, I would say that over ninty percent of my practice is solely dedicated to performing traditional nonsurgical and surgical endodontics.
How is your clinic different than standard practices outside of the military system? How?
We have a 36 chair dental clinic, which is one of largest dental clinics in Europe. We provide comprehensive dental care, so there is a lot of interaction between the general dentists and the specialists. Because it’s designed like a large group practice and money isn’t an obstacle when making treatment planning decisions, we are able to provide ideal care for the patient. It’s also enjoyable in that there is a real feeling of camaraderie between the dental providers and everyone is willing to share their knowledge and clinical skills with everyone else. It’s also nice to collaborate with several specialists under the same roof for consultations and treatment planning of complex cases.
Do you choose your own products and equipment? If so, what systems do you use?
Within reason, I’m allowed to make my purchasing decisions and product choices based upon my personal preference. I currently use a Zeiss PROergo microscope (Carl Zeiss Surgical) with a floor stand, which provides excellent visualization and light during endodontic procedures. It allows me to see the “road map” at the pulpal floor to assist in finding calcified canals or to remove obstructions . For profound anesthesia, especially for lower molars with irreversible pulpititis, I regularly use the X-Tip intraosseous anesthesia delivery system (DENTSPLY Tulsa Dental). My predominant choice of files is the ProTaper rotary endodontic files (DENTSPLY Tulsa Dental) with AH Plus sealer (DENTSPLY Tulsa Dental). The ProTaper files are flexible, efficient and produce nicely shaped canals for obturation. I have also recently begun using the Twisted Files (Sybron Endo, Orange CA, USA) and have been pleased with their performance. I use Elements Obturation Unit (Sybron Endo, Orange CA, USA) for both my warm vertical compaction heat source and warm gutta-percha. The wand with a button pressed gutta- percha cartridge is easy to get into small spaces and allows for smooth gutta-percha flow. The MiniEndo Ultrasonic unit (Sybron Endo, Orange CA, USA) allows me to uncover calcified canals, remove posts and refine my access preparations as needed. We recently had digital radiography with Schick sensors (Schick Technologies Inc., Long Island City, NY) installed throughout the clinic, which makes taking radiographs much more convenient and allows for significantly lower radiation doses when compared to film based radiology. The digital radiographs make case presentations to the patient more convenient as well as sending and receiving consults via email.
My practice has become much more surgically oriented and I use Pro-Root MTA (DENTSPLY Tulsa Dental) regularly as a retrograde filling material. MTA is very biocompatible and is designed to set in a wet environment. While performing apicoectomies, I frequently place bone grafts with irradiated allogenic canellous bone and marrow (Rocky Mountain Tissue Bank, Aurora CO) with a Bio Gide resorbable collagen membrane (Osteohealth, Luitpold Pharmaceuticals, Inc Company). When performing apicoectomies with a large periapical radiolucency, the bone graft acts as a lattice for bone regeneration and helps completely fill in the bone defect.
Who has inspired you?
My endodontic mentor from dental school, Dr. Joseph Legan definitely was a major influence on me professionally due to his hands-on approach to teaching and his love for endodontics. My program directors at my endodontic residency program, Dr. Joyce, Roberts, and Sidow also have all inspired me in different ways from their dedication to teaching. One such lesson was to treat my patients with kindness, dignity and always provide the best possible care for the patient.
I also have several professional heros that I look up to including John West, Cliff Ruddle, Steve Buchanan and Syngcuk Kim. Their passion for endodontics has inspired me to continually improve my clinical proficiency and quest for excellence. I appreciate their willingness to share their talents and abilities with others to help improve the profession as a whole. I’ve also been able to interact with each of them at various endodontic meetings and have found them to be very fun, intelligent and down to earth individuals. They each have a gift of taking complex subjects and breaking them down into a clear, user-friendly manner.
What is the most satisfying aspect of your profession?
I enjoy solving people’s endodontic issues and doing it as pain free and stress free as possible. Root canals have gotten a bad reputation among the population at large, right up there with paying taxes. It’s nice to complete a case and have the patient say, “wow, I was really nervous about the root canal, but that didn’t hurt at all”. I also enjoy the human interaction on a daily basis with both the patients and the dental team. As with all the healing arts, I feel endodontics is both an art and a science, with every case representing a unique challenge. I’m striving to change patient’s perception of root canals one patient at a time through patient rapport, efficient techniques and good anesthesia.
Professionally, what are you most proud of?
It truly is an honor to have completed an endodontic residency program and to be part of a very rewarding specialty. It’s nice to attend national endodontic meetings and see friends and colleagues year after year. The global endodontic community really is a small, close knit group when you compare the amount of practicing endodontists with the general population.
I also feel proud of the opportunity I’ve had to serve the dental needs of US Service members and their families for the past 6 years. Soldiers and their families make great sacrifices to serve their country and it’s been an honor to provide care for them in my own small way as a military endodontist. Whether I go into private practice when my initial military commitment is up or make the Army a career, I will always feel honored for the opportunity I’ve had to serve in the U.S. Army Dental Corps and the people I’ve been able to work with.
What do you think is unique about your clinic?
Practicing in a large American style group dental clinic in Germany is very unique in itself. Our clinical staff is made up of active duty soldiers, civilian contractors and local German nationals all working as a team. There are unique challenges with such a diverse group, yet our diversity is also a great strength. Everyone is committed to providing the best dental care possible with the manpower and resources available for our population.
The camaraderie that exists between the care providers is also unique in that everyone is willing to mentor and share ideas with the other providers. There is a wide range of experience among the providers. Our clinic has dentists who have been practicing for over 30 years, newly graduated dentists and everything in between. This range of experience provides a wealth of information and clinical knowledge to share among the providers and collaborate on challenging cases.
What has been your biggest challenge?
As with any large organization, there are limits to the amount of personnel and resources available. Our challenge is to provide the best care possible for the greatest number of people. We also have a unique mission in that our first priority is maintaining the dental readiness of the soldiers within our community. Our treatment load can vary widely based upon our soldier’s deployment and training schedules. This can be challenging at times, yet our clinic personnel are accustomed to these variations and handle the fluctuating treatment loads well.
What would you have been if you didn’t become a dentist?
That’s an interesting question because as I mentioned previously, I changed my major several times in college while trying to figure out what I wanted to be “when I grow up”. I probably would have done something else in the health care field because I enjoy helping others and like the social interaction as a health care provider. It’s also possible that I would be doing some type of consulting because I enjoy learning about and implementing best practice systems and strategies that make businesses or organizations more effective. I’ve learned that small changes in the way I perform a procedure can make a big difference. Once I learn a better way of doing things, I enjoy sharing the ideas with friends and colleagues that may have similar challenges. There is a Japanese term called kaizen, which refers to continuous improvement. My goal is to continuously make small improvements in all areas of my life in order progress and keep life fun and challenging. By implementing a philosophy of continuous improvement, people can find success, joy and satisfaction in just about any endeavor they’re involved with.
What advice would you give to budding endodontic dentists? Would you recommend the path you have chosen?
I would recommend performing as many endodontic procedures as they can as well as shadowing other endodontists and see if this is the right specialty for them. There are many ways to make a living and you want to make sure that endodontics is something you will enjoy doing on a daily basis. It’s also helpful to speak with endodontic program directors and endodontic residents either formally or informally to get a good feel for the specialty and the strengths of different residency programs. Being that it’s competitive to be accepted into an endodontic residency, I often tell friends that the best residency program is the one that accepts you. With that said, you also want to look at financial considerations for the program and whether or not you will enjoy living in the area for two or three years.
I would recommend the path I have chosen to anyone who enjoys endodontics. Despite the challenges currently facing our profession, I feel the future for endodontics is bright and the best years are yet to come. Dental implants will change the landscape of our specialty in various ways, yet I feel the best possible option for patients is to keep their natural teeth if possible. I also feel that we as endodontists need to do a better job educating our referring dentists. We need to educate them on not only what we can do, but why many times it’s in their own best interest as well as the patient’s best interests to refer many of their endodontic cases to a specialist. As we focus on providing solutions to the general dentists problems, we will assist them in meeting their patient’s needs and will be rewarded accordingly with more than enough endodontic referrals.
What are your hobbies and what do you do in your spare time?
My biggest hobby is spending time with my wife Alissa and our four children. After a busy day at work, it’s nice to go home and hang out with my family to relax and recharge my batteries. I also enjoy working out, including training in a form of martial arts called Brazilian jiu-jitsu. I began training in jiu-jitsu in 2003 and have been hooked ever since. In my spare time, I enjoy reading, especially biographies, self-improvement books and dental publications.
While living in Germany, I’ve been able to travel quite a bit and enjoy visiting other cities throughout Europe. After growing up in the United States, it’s amazing to visit so many countries within a day’s drive while we’ve lived oversees. There is so much history in Europe and its fun to learn about other people’s culture and customs.
Zeiss PROergo Microscope (Carl Zeiss Surgical)
X-Tip intraosseous anesthesia delivery system (DENTSPLY Tulsa Dental)
ProTaper rotary files (DENTSPLY Tulsa Dental)
AH Plus Sealer (DENTSPLY Tulsa Dental)
Twisted Files (Sybron Endo, Orange CA, USA)
Elements Obturation Unit (Sybron Endo, Orange CA, USA)
MiniEndo Ultrasonic unit (Sybron Endo, Orange CA, USA)
Schick digital sensors (Schick Technologies Inc., Long Island City, NY)
Pro-Root MTA (DENTSPLY Tulsa Dental)
Irradiated allogenic canellous bone and marrow (Rocky Mountain Tissue Bank, Aurora CO)
Bio Gide resorbable collagen membrane (Osteohealth, Luitpold Pharmaceuticals, Inc Company)
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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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