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Title:
Interview with Thomas B. Bruff, March 11, 2005
Date:
March 11, 2005
Description:
In this interview, Dr. Thomas B. Bruff relates his experiences with dentistry, from the training he received in dental school to his twenty-plus years as a practicing dentist. Dr. Bruff also discusses changes and constants in dental technique (including the use of mercury in amalgam fillings), the costs of opening a practice, and his personal philosophies about the practice of dentistry.
Phys. Desc:

Interviewee: Bruff, Thomas Interviewer: Zarbock, Paul Date of Interview: 3/11/2005 Series: SENC Health Services (Dentistry) Length 57 minutes

Zarbock: Good morning. My name is Paul Zarbock, a staff person with the University of North Carolina at Wilmington's Randall Library. Today is the 11th of March in the year 2005, and we are in Wilmington, North Carolina, at the office of Thomas B. Bruff Junior. Dr. Bruff is a dentist here in private practice in Wilmington, and we're going to be chatting a little bit about how did he become a dentist, why did he become a dentist, and what's new in dentistry. So, good morning Dr Bruff.

Thomas Bruff: Good morning, thanks for having me.

Zarbock: What event, series of events, individual or series of individuals led you into the selection of dentistry as a profession?

Thomas Bruff: When I was growing up, I-- an uncle, my mother's brother is a family physician, and I always just had the greatest admiration and respect for my Uncle Mac. I wanted to go into uh.. medicine one way or the other becau- because of him. I just figure- thought he was just the most brilliant, the smartest man to- to walk the face of the earth, and I wanted to be like- like he was. (ringing phone) In high school, we got into the- when I was in high school (ringing phone) we got into the uh.. Vietnam war, and coming out of high school, I graduated from high school and I wasn't sure I wanted (ringing phone) to go into uh.. college right away, I didn't know what I really wanted to do. I...

Zarbock: What year was that, Doctor?

Thomas Bruff: That was in 1967.

Zarbock: And by the way, where is hometown for you?

Thomas Bruff: Home was in Hampton, Virginia. My father was career military and he retired at Fort Munroe, Virginia. And out of high school I went to work for a friend and we did some carpentry, and I ended up getting drafted and uhm.. sent to Vietnam. Coming out of Vietnam I started my college education, and after four years at the University of North Carolina studying chemistry I- I started to apply to medical school and dental school. And started to realize that in medicine I would have been comfortable going to some type of surgery, I've always enjoyed working with my hands. I-- as a child, I enjoyed building these model airplanes, and always have enjoyed drawing and uh.. wanted to do something with my hands. I did not want to be the family doctor that my uncle was, but something in some kind of surgical realm and- and adding things up, four years undergraduate, four years of medical school, four to five, six years in- in a surgical uh.. residency, because I'd started late, my age became a factor. And I figured I could do the same thing in dentistry. Work with my hands, I've always had a uhm.. sincere desire to help people, but a lot of that decision was based on my ability to come in and work with my hands in a field that I thought would make me happy because I felt that would make me happy, doing- doing something with my hands. So it was- it was more of a combination of wanting to go into the medical field, and being a little bit older that brought me into dentistry.

Zarbock: What were you doing in Vietnam, by the way? What assignment did you get?

Thomas Bruff: When I- when I was drafted, I figured that if I was gonna go to war I wanted uh.. do- do something that wasn't directly in- in the line of fire. So (laughs) so I went into a computer repair school and they sent me to uh.. school for nine months. The- the drawback to that was having to uh.. sign up for a third year, but I figured, sign up for a third year if I spend most of that in school. Went into uh.. single-core uh.. computer repair in uh.. Fort Monmouth, New Jersey. And uh.. because of that, uhm.. didn't see too much action in Vietnam. But boy, that was a decision coming out of the army, wondering should I continue in computers, which was a, you know, big and growing field back in, this was about 1971 uh.. or uh.. pursue my dream of uh.. something in the health profession.

Zarbock: Computers in those days may have been called transportable, but they were really luggable.

Thomas Bruff: (laughs) They really were. This was when we're still working with the tubes, we had none of the integrated circuits we've got today, these things were massive machines. The ones we had in the-- the computers we have in this office you can put on your arm and walk out the back door with, but boy the ones we had in Vietnam, and- and this was the US Government, so we had some of the best and the finest, you know, equipment you could buy. And these things were massive.

Zarbock: Am I correct, you did not consider the military as a career?

Thomas Bruff: Not really, no. No, not really.

Zarbock: What was your rank when you got out?

Thomas Bruff: I was a Sergeant, an E5. I was in there for two years and nine months and got out as a uhm.. E5.

Zarbock: How difficult was it to readjust to civilian life?

Thomas Bruff: Not- not difficult at all. Uhm.. Not- not for me, because again, I grew up in a military family and it was uhm.. something that uhm.. more my father was so proud of me going into the military, and he might have w- wanted me to stay in as a career, but no- no real adjustment at all for me.

Zarbock: Was dad navy?

Thomas Bruff: Dad was army. Uhm.. stayed in r-- he was in the military, I think, for 30 years. Retired after 30 years.

Zarbock: So we've got you discharged from the United States Army, and you're not too sure if you should choose choice A or choice B. Was there a defining moment when you said "Dentistry is it"?

Thomas Bruff: Not really. Uhm.. not really. I- I considered it. I- I always- again I always had wanted to go into health professions. Always wanted to be a doctor. Uhm.. always wanted to do something along those lines. So I never really considered maintaining my presence in the computer field, I- I had always, even during my time in the military, had ... c- continued to, you know, pursue my dream of going into the health professions, but there were times when I would think about, saying "You know, I- I might be making a mistake here. I might not get into medical school. I might not get into dental school. Maybe I should pursue this." But I never really took that seriously.

Zarbock: Where did you apply to dental school?

Thomas Bruff: I applied at the University of North Carolina, and Medical College of Virginia, those are the only two that I- that I applied to.

Zarbock: And you ended up in Virginia.

Thomas Bruff: Ended up in the Medical College of Virginia. I was put on a waiting list at the University of North Carolina uh.. but I- I took the position at uhm.. Medical College of Virginia when it was offered.

Zarbock: And what year was that?

Thomas Bruff: 1980.

Zarbock: Dental school is how many years?

Thomas Bruff: Four. Four for the uhm.. general practice degree, and you can go specialty years, two years or four years to- to obtain a specialty degree.

Zarbock: So what year did you graduate?

Thomas Bruff: Finished in uh.. '84.

Zarbock: Any one who has ever spent more then 15 minutes in a situation of higher education quickly finds out there are some classes that are just fun to have and other classes that are a chore. What were your chore classes, and what were your fun classes?

Thomas Bruff: Oh the- the chore classes were uhm.. the chemistry classes. That was my major, but chore classes were some of these organic chemistry classes. These- this organic chemistry to me was like a foreign language, it was something that was uh.. I took Spanish as a foreign language, but the organic chemistry for anybody who has taken it, all the various names, you have to learn this whole new uhm.. system of naming uhm.. chemicals and compounds, and it was much like a foreign language that was uhm.. a chore to uh.. just sit down and uh.. go over. Uh.. the math, I have never been a math major, I-- you can-- one of my heroes has always been Isaac Newton. Isaac Newton uh.. invented calculus, and you can sit down and talk to me about calculus for an hour and I still don't understand it. So anybody who could sit down and come up with this out, you know, out of the-- off the top of their head, am I impressed with. So my chore classes were the- the math, the physics, I enjoyed the chemistry classes except for organic, which I thought was very extraneous.

Zarbock: I'm going to go back to the application process. I interviewed a dentist in Southport not so long ago, 75 year old man, and he was saying that part of the application process was they gave him a piece of chalk, I believe it was, and some sharp instruments and told him to carve a tooth. And they showed him a picture of a tooth. And he did. Was anything like that involved in your application process?

Thomas Bruff: Not in the application process it wasn't. But in the uh.. our first class-- we got there in the summer of '80, and w- our first class was a gross anatomy which- which lasted all summer. Our second class was a dental anatomy in which we were given little cubicles of wax and asked to carve teeth. And what they'd asked us to do prior to arriving at school was to go around to various dental offices and acquire uh.. teeth that had been extracted, teeth that were in good shape, no decay in them, no filings in them. And I still collect those today and- and send them to the dental school. Uh.. although they have done away with that now. It's my understanding they- they no longer expect you to carve up a tooth, but they would give you a little cube of wax and tell you to pick out a mandibular first molar and to uh.. carve it up, and you had about an hour, hour and a half to- to do it.

Zarbock: So it was a timed exercise.

Thomas Bruff: It was a timed exercise, and uhm..

Zarbock: Then who juried the result?

Thomas Bruff: The- the professor. The professor uh.. in our case uh.. Doctor Jones. And he had uh.. assistants within the class and they would sit down and- and look at these uhm.. they would look at your tooth and what- how your little cube of wax resembled that tooth. And- and you were graded accordingly.

Zarbock: Well theoretically at least, you could flunk.

Thomas Bruff: Theoretically you sure- uh.. certainly could flunk. Certainly could if it turned it looking like a cow pie when it's supposed to be looking like a first molar, yeah you could flunk.

Zarbock: And would that be the end of your dental career in the event that you flunked that particular exercise?

Thomas Bruff: I think maybe that was part of the discussion to do away with that. Would that necessarily be the end of your dental career if you couldn't carve up a tooth? I don't- I don't think so. I think that uhm.. that is a-- your dexterity can be developed, it can be refined and- and you- and you can certainly improve on it. So just because we can't carve up a tooth out of wax doesn't necessarily mean we can't perform the job. And maybe that's why they've done away with that. Uhm.. but they-- it's my understanding they have done away with that little procedure of carving teeth.

Zarbock: But carving teeth was still part of the curriculum in the year...

Thomas Bruff: I still have them. I still have my teeth. (laughs) I still have my carved up teeth.

Zarbock: And what year was that?

Thomas Bruff: Uh.. that would have been 1980 that I f- one of my first dental classes.

Zarbock: Do you know when they discontinued that procedure?

Thomas Bruff: It's my understanding they discontinued that two or three years ago. So I've been practicing now 21 years, and that was just recently discontinued.

Zarbock: Is this a universal dropping of the requirement?

Thomas Bruff: No, I- I'm not sure about that, Paul. But uh.. I know at Chapel Hill it- it is, yes.

Zarbock: But each dental school is it's own personal kingdom.

Thomas Bruff: Right, sure.

Zarbock: You set the curriculum, and that's...

Thomas Bruff: Sure. You have- you have national boards upon graduation that- that tries to make sure everybody's taught with, you know, within the same realm. And then you have state boards that you pass. And- and the state board gives you your license to practice within that state, but I think that's- that- the national board tries to make sure we have some kind of cohesive instruction.

Zarbock: Tell me a little about the national board, is that a pen and pencil test?

Thomas Bruff: Yeah. The national board is a pen and pencil test, takes you maybe hour or hour and a half to- to uh.. finish this test. The- the state board however has a clinical aspect to it where you're asked to perform uh.. various dental uh.. procedures to include an extraction or uh.. a filling or uh.. cleaning of- of a patient. Uh.. make a crown, fabricate it, cast and uh.. deliver a crown. Fabricate uh.. a partial denture, or a full denture.

Zarbock: All of these were required?

Thomas Bruff: Yes.

Zarbock: All of these clinicals?

Thomas Bruff: Yes. This- the-- on your- on your state board, it was a three-day event. And you brought your own patients- patients to the school. And that was- that might have been one of my uh.. problems with uh.. leaving Carolina and going to the Medical College of Virginia 'cause when I came back to Carolina to take the state boards, I didn't know anything about their dental school. So- but you had to bring your patients with you. Put them up in a hotel and...

Zarbock: I'll be darned. Now that is a surprise. Well that really is patient/doctor relationship, isn't it.

Thomas Bruff: Yeah. Uh.. patients would make or break you on this- on this test. Uh.. so you wanted to get a patient that uh.. was very uh.. compliant, that was a good patient and didn't squirm around and was easy to work on.

Zarbock: And you'd have to do an extraction?

Thomas Bruff: Yes. You had to do an extraction of a mandibular molar.

Zarbock: My land.

Thomas Bruff: So you had to find a patient that needed that done.

Zarbock: How would you recruit patients?

Thomas Bruff: Well in- in dental school, the patients would come through. The dental schools are a great uh.. opportunity for some people to have some great dental work done free. And as these patients came into the school, they were allocated to- to various students so that you had a pool of patients to pull from. And as you started to get (inaudible).

Zarbock: Was that a little joke?

Thomas Bruff: No. But uh.. it- it gave you the opportunity to, as you became a senior to sol-- you knew what the requirements were going to be for the state exam. You kn- you knew that you were gonna have to uh.. do an extraction. You knew you were going to have to do a crown. Uh.. you knew you were going to have to do a filling. You knew you were going to have-- you were going to be tested on your ability to uh.. fabricate a denture. Uh.. to clean a patient. So you were- you could be select about your pool that was offered to you by the dental school, as "This patient needs an extraction, but lets-- would you mind coming down to Chapel Hill with me and letting me do it down there?" So you- you just pick from your pool of patients, and that's what I-- that's what everybody did and you bring them to- to dental school to (inaudible).

Zarbock: Now I'm going to take you to a very low-level question. I mean it's low-level to you. You're in dental school and you're going to learn how to repair a cavity. Well, I assume you had not practiced, well how did you go about repairing the cavity the first time you did it?

Thomas Bruff: The- the first time you started to work on teeth you were actually working on the- some of the extracted teeth that you collected during the summer prior to your freshman year, or had continued to collect throughout the years. You would take these extracted teeth and you would mount them in stone, and you would arrange them so that they appeared to be uhm.. an arch, where you had the- the pre-molars and the molars, everything lined up. And they would ask you to drill on these teeth. "Pretend I'm- pretend on this uh.. tooth you have a distal cavity, prepare a distal prep on this tooth." So you were actually cutting on teeth, but they were mounted in stone for your- for-- I think that started in the sophomore year. A lot of that initial work was done either on uh.. plastic teeth or extracted human teeth before we got to the patient.

Zarbock: What about giving shots?

Thomas Bruff: Giving shots, first shots we gave we gave a shot in o- to a orange, just to get the feel of it. Then in- in dental school you were always matched up with a partner. Paul Brown was my partner and- and he did- he and I did things together for four years. So the next shot you gave, you know, I- I had to give Paul a shot, and he had to give me a shot. Uh.. first shot you'd ever given, and that was uhm.. that was pretty tense for me, although Paul was a, you know, a great guy and a good student, it was-- that was pretty stressful for me having to get a shot from him who ain't never done it before. But that's- that's how we did it, we g- gave it to each other. We were our own little guinea pigs.

Zarbock: And then what? Practice begins to give you some confidence after that?

Thomas Bruff: Practice began- it began to give you some confidence, and uh.. you know, we'd try, you know, very hard. They'd beat it into your head, you know, "Whatever you do, do not go into that patient and say 'This is the first time I've done this. I know you're a little apprehensive, but so am I. I-- this the first time I ever done this.'"

Zarbock: Lets see if I can fly this airplane, if I can find the starter switch.

Thomas Bruff: So it, you know, these patients understand that. The- they were ne- they were never told that this was the students' f- first time at it- at this procedure, but they knew that- that these were students.

Zarbock: Now you also said the demand was placed upon you to design and develop a partial plate?

Thomas Bruff: Partial plate and full plate, uh-huh.

Zarbock: And again, how would you go about this?

Thomas Bruff: Uh.. this-- again this was uh.. (clears throat) something that they, the school had developed- developed you to do. In- in the school it was, everything was so tedious. Everything was so uh.. you had (ringing phone) to conform so much to what the school wanted you to do, and you were overseen every step of the way. You couldn't do anything. Every ten minutes you had to stop, raise your hand, let somebody come over and check you. So it was just a matter of uh.. routine and uh.. repetition. Where you ju- you worked on the partial denture or the full denture for months until you really kind of got a hang- the hang of it. And- and again, these dentures were made for nobody in particular. These were made on a study model. These were not made for a patient, so you really-- they really (ringing phone) worked you for a year or two just on that, and then they would let you go. You didn't go into see stu- uh.. patients until your junior year. So your freshman and sophomore year you were doing stuff on uh.. on the bench and not on a patient.

Zarbock: Let me fast forward. When's the last time you did a partial or a full? Designed it?

Thomas Bruff: Uh.. today is uh.. Friday. Yesterday.

Zarbock: So that early orientation to the practice of dentistry has continued through out your professional career, now twenty-some years.

Thomas Bruff: Absolutely. Absolutely. And uh.. but it does get-- as a- as a general dentist, you- you reach the point of ... uhm.. the procedures that- that I like to do versus procedures that I have to do, uhm.. a lot of general dentists enjoy doing the orthodontics. A lot of general dentists might prefer the oral surgery aspect. A lot of general dentists like to p-- might like the removable partials, or the fixed uh.. prosthetics, you know, the gold and the porcelain. And you kind of fall into a groove of patient selection. If- if I don't particularly want to uh.. mess around with a wisdom tooth extraction, that's why I- I have the oral surgeon. So it uh.. you kind of, you get to a point where you're- you're picking and choosing what you want to do. Uh.. as far as a partial denture or a full denture is concerned, I pick and choose the ones that I think might be the easiest and I'll send the other ones to the prostidontist, that's what he's trained to do.

Zarbock: Doctor, I graduated from the University of Wisconsin, a major research facility, in 1956. I over the years have discovered that at least 50% and maybe higher then that of the materials offered to me, intellectual materials offered to me, are found to be inaccurate or floridly wrong. Well, during your 20 years of clinical practice, how has clinical practice changed in your 20 years? What has dropped off, what has been added?

Thomas Bruff: One of the first and most obvious uh.. things that has changed, and when I got out of dental school in '84 the dentists, we were still wearing shirts and ties to work on the patient. We didn't wear masks, we didn't wear gloves. We didn't wear any eye protection. We would come in and sit and work on the patient in our street clothes, shirt and tie. Some of us might wear a- wear a- a clinic jacket over it, but most of us wore the shirt and tie. One of the biggest aspects of change in dentistry has been just that, our awareness of uh.. microorganisms and the transmission of uh.. various diseases between uh.. patients or the uh.. patient transmitting something to the dentist and so as now, we- we come into the office, we'll change into our scrubs, clinic jacket if- if you like, work on the patient, come back, take it off, put the street clothes back on, go to lunch, come back and change again. End of the day, change it. Uhm.. all of your uh.. scrubs, all of your clinic jackets are put into a bag and uh.. washed separately. We have a washing uh.. washer/dryer here on the premises and- and we take care of all the-- ourselves and our staffs' uh.. uniforms right here on the premises, washing them. But one of the things that- that changed in dentistry uh.. is the use of (clears throat) fiber optics. Coming out of- coming out of dentistry in '84 we didn't have the lighted hand piece. Uh.. it was-- vision has always been a problem, getting that light down into the mouth so you can see has always been a problem, but since I've been out of school they have developed fiber optics where they have the fiber optic in the hand piece, particularly the high speed hand piece, and it just lights up that whole field for you. That- that's been a uh.. great help. Sometimes my fiber optic will go out and we have to replace the uh.. bulb, and I'm just as blind, I don't see how they-- how dentistry was done without those, without that uh.. vision aid. Uhm.. along the same lines, one of the big changes since I've been out is the light-cured uh.. materials that we use. Coming out of dental school, most everything we mixed up, whether it was the cement that we used to hold the crown on or the tooth-colored filler that we used to- to patch up a tooth in the front of the mouth, it was a base and catalyst where you mix half of this and half of that, and mix it together, and it would set hard as a rock within about a minute and half. So you had about a minute and half to get that thing in the mouth, get it situated and then it hardened. One of the things that uh.. we use a lot of now is light-cured, where we can mix two things together, we can put something in the mouth, and we can cure it when we want to cure it. It doesn't cure on us, so it's not a uh.. self-polymerizing, it is a light-polymerizing. And we use that with everything across the board.

Zarbock: But it has the same efficiency.

Thomas Bruff: Uh.. yes. The- the materials over the years have gotten better and better and better. Uh.. but one thing that- that remains today (clears throat) is the amalgam filling. The amalgam filling has been used in dentistry for I think 250 years, and it will probably be used forever. The old standby never goes away. But a lot of your uh.. composite resin, the tooth color fillers have their consistency, their makeup has changed so much to make them easier to place, easier to pack, uh.. more of a uh.. something that might contour better, but all of those are uh.. light-cured.

(crew talk)

Zarbock: My question was going to be, who has done the research and development of these new materials?

Thomas Bruff: Materials. Uhm.. there are- there are certain dental schools that are renowned for uh.. their research. University of Michigan, for example, has a s- has a great research program. And uh.. and we have to rely on that. As- as a private practitioner I'm not in the market of doing any research. I- I can't test this material versus that material on patient A versus patient B and see which one lasts the longest. Uh.. so there- there are a group of dental schools, and the one that comes to mind is the University of Michigan, and they do a lot of this research for us. A lot of your manufacturers, the- the uhm.. people that might produce some of these...

Zarbock: Dental supply houses.

Thomas Bruff: ... dental supply houses will come to various schools, if not all schools and ask them to run a trial basis where the students use this material; try this technique. But there are certain dental schools, and again University of Michigan uh.. has a much larger program then- then some others, that will uhm.. do this research for us. And that is publicized.

Zarbock: When you started off in dentistry, where they still using mercury?

Thomas Bruff: Sure. That's the- the amalgam filling that I was talking about. It- it was just applied differently. When I first got into dentistry you literally mixed the amal- the mercury with the uh.. various metals in a little- in a container yourself. Now it's a self-contained container that you crush it to- to mix the- the mercury with the- with the powdered uhm.. metals, put into a machine that just vibrates it, and it mixes it together, you pop it out, pick it up, put in a patient's mouth.

Zarbock: You say mercury, and people begin to perspire heavily.

Thomas Bruff: Yeah they do.

Zarbock: What is the role of mercury in dental practice?

Thomas Bruff: The- the mercury acts as a uhm.. matrix to hold the various metals. Amalgam has four, five, six different metals in it, it's a true alloy, and the mercury holds these metals together, and binds them together creating uh.. the- the strength. But there's- there's been fear for the last ten or 15 years, a lot of this on TV, of this mercury. But this fear is- is not well-founded; I don't think we will ever dispense with that amalgam filler. If the mercury was that much of a problem, wouldn't we expect the dentist or the dentist's assistant to start to sh- show signs of mercury toxicity and not necessarily the patients? I'm- I'm using this mercury hours every day, days every week, throughout the year. Would I not show signs of mercury toxicity? Or my assistant? Every time we place an amalgam filling, we are exposed to the mercury vapors. Every time we remove the amalgam on an old amalgam filling that might be fractured or have some recurrent decay around it, we are exposed to the mercury vapors. And not-- there is not a uhm.. there's no evidence to support-- there's no evidence to show that any dentist or assistant has been affected with this uh.. "Mad Hatter Syndrome" it- it was once referred to. There are- there have been some patients who have through- throughout the United States, a handful of patients who have claimed that it was the mercury that caused them to have this reaction or that reaction, but uh.. following up on those patients, it- it came down to more of a uh.. allergic response to one or more of the metals within the amalgam alloy a- and not necessarily the mercury. W- the only- the only true-- real problem we have with this mercury today is the uh.. eradication of it out of the practice, disposing of it. Getting rid of the mercury that we have, the scrap mercury that we have, the mercury that might come out of a filling. If we're taking a filling out and we still have a chunk of mercury there, if it goes up into the suction, our suction has a uhm.. filter on it which will catch that mercury, or catch whatever goes up the suction in- in bulk, and we dispense of that. And that's dispensed with a hazardous uh.. waste program where it's placed in a container underwater and these people come by about once a week and pick this up and dispense it uh.. dispose of it I mean, in the uhm.. waste plant here in- in Wilmington where it is literally uhm.. melted and vaporized.

Zarbock: Incinerated.

Thomas Bruff: Incinerated, uh-huh. That's the real problem with mercury is the uh.. disposal.

Zarbock: And mercury comes in other forms and enters the body in a variety of other ways.

Thomas Bruff: Sure. O- one of the things we see here in Wilmington, you know, is the uh.. recreant fish.

Zarbock: Yeah. Absolutely.

Thomas Bruff: So that's why we're real concerned, the dental practice, the dental field, the dental family, very concerned about proper disposal of this mercury.

Zarbock: But it generated an awful lot of headlines, didn't it?

Thomas Bruff: It did. It did and- and maybe too a uh.. too a- a lot- a lot of it was not justified. A lot of it was uh.. you know, just really a fear that uh.. some of these- the news media placed into patients, and was never substantiated. So we- we still use it, and we probably always will. I would imagine we always will use the amalgam filler.

Zarbock: What about the imaging equipment, x-rays, how has that changed, if so, in 20 years?

Thomas Bruff: Uhm.. the big change is uh.. I've been again in practice 21 years and within the last five or eight years we've come out with this digital. The electronics has uh.. reached a point where everything has been uh.. digital. All of your x-ray units now are uh.. digital and- and not necessarily the use of the film where the film is exposed, and we now take the film and we will develop it with a- put it in a uh.. processing unit which will develop the film for us, or we can uh.. use our dip tank and develop it ourselves. Uh.. today's x-ray units are used where you take the uhm.. x-ray, the x-ray is transmitted by uhm.. wires to the computer, the computer generates the image, and prints out the uh.. image for you where there's no real film at this point.

Zarbock: Back to when I started 20 years ago, none of that was...?

Thomas Bruff: Uh.. had no clue. Never heard of digital. This was just a film like camera film and you developed it the- the same way.

Zarbock: By the way, what does the law require of you? How long do you have to maintain these images?

Thomas Bruff: It- it's relative, but you maintain the patient's record for ten years. Uh.. you- you're required by uh.. federal law to maintain these records for a period of- of ten years. Uh.. the x-rays I'm not sure, but you need to re- retain them for five. But all the other records, any kind of written record, any kind of uhm.. referral records, maintained for ten years and then is disposed of with the- through the incineration.

Zarbock: Well we've drifted into a situation of law and ordinances, what about the condition of malpractice? This a hot topic in any health care delivery system profession. What is the condition of malpractice suits brought in dentistry? Do you hear much about them?

Thomas Bruff: They- th- this is- this is one of the things that has infuriated all of your physicians, whether they be dentists, or uh.. brain surgeons, neurology, uhm.. neurosurgeons, is the way lawyers have gotten into uhm.. these sometimes unjustifiable lawsuits. Doctors are human, and- and they're going to do the best that they can, but sometimes mistakes are made. And for the lawyer to jump right in and sue the doctor has created all kinds of problems, these frivolous lawsuits, I'm talking about, have re- have created a lot of problems with our health insurance. Our- our health insurance today, the premiums today are more then triple what they were 21 years ago when I came out of dental school, primarily because of these frivolous lawsuits, everybody trying to find fault with- with the doctor. That the doctor has to perform, the dentist has to perform perfectly or they're gonna get sued. And that is always hanging over your head. Now we understand that as long as we can document, as long as we can talk to the patient, as long we as can warn the patient-- patients do not want to be surprised. If you'll sit your patient down and discuss, "This is what we're gonna do. These are the various outcomes that we- we might see. And this may not going according to the way I want it to go, and it may not be to your satisfaction, but you have to understand that this is one of the uh.. two or three consequences of doing this procedure. If you'll sit your patient down and talk to them along these lines, and warn them of all the probable- probable consequences or uhm.. sequences of events following this procedure, you're gonna be- you're gonna be alright. But even doing that, if- if any little thing goes wrong, lawyers have been so quick to pick up on this uhm.. lawsuit that it's created a lot of problems, and as you know, within the last year or two, there's been a lot of uh.. legislation brought up within the uh.. state senates, the- the state uhm.. bureaucracy and the federal uh.. in DC to try to eliminate these frivolous lawsuits because they are just elevating the cost of medical malpractice right through the ceiling. Uh.. today it's not uncommon to look in the newspaper and see where an orthopedic surgeon, or a obstetrics, or a gynecologist, or a oral surgeon has decided to discontinue practice because of the expense of the malpractice to maintain his business is just overwhelming, and all this comes from the frivolous lawsuits that uh.. should be thrown out. There's got to be a little uh.. leeway between the doctor's perfect performance and the clinically accepted performance.

Zarbock: Without giving the dollar amount, only the percentage, roughly what percentage of increase has taken place in your malpractice insurance 20 years ago vis a vis now.

Thomas Bruff: A hundred percent. It is more then double.

Zarbock: And what will be done unto you if you don't maintain it?

Thomas Bruff: Oh, i- if you don't maintain it, uh.. y- you run the risk of having uh.. your livelihood taken way. As long as you have the malpractice, I'm not worried a- about being uh.. sued. I'm not worried about facing a malpractice uh.. claim, that's why I have the malpractice, I'm gonna let them worry about it. But uhm.. without it, if you were- if you were taken to court, how would you come up with the money that, you know, you'd have to sell your practice, you'd have to sell your house. That's why you have the insurance.

Zarbock: When I was a young boy, which is many years ago, it struck me that most dentists operated on the second floor of some building, and they had their names on the window probably in gold, kind of gothic type stuff. And that was it. I mean, that was the marketing of the day. Well those days have changed. What is the current situation, again vis a vis 20 years ago and now when it comes to marketing your practice? How do you get the word out that you are capable and good?

Thomas Bruff: When I got here to Wilmington, this dental community was very proud of the fact that the marketing, or the cost that was spent on advertising or marketing was very low. They prided themselves in the fact that they felt like the work of mouth was the best, the- the uhm.. best way to acquire new patients, and that you did not need the yellow pages, you did not need the bulletins, you did not need advertising on radio or TV, and- and although somewhat idealistic, that's true today, that your- your best source of referral is gonna b- is gonna come from your patients where your patients can tell their friends, "Yes I- I like Dr Bruff. He treats me right. He seems to be sincere in wanting to help me, and he's very gentle, or he very uh.. empathetic." But over the years we've come to realize that y- you really can't ride herd on- on the dentist uh.. to advertise the way they want to. I- it hasn't really-- marketing your practice hasn't really changed because the media really hasn't changed. When I got out of dental school we- we had TV, we had radio, you had the uhm.. ability to manufacture little bulletins and walk around and stick em on people's, uh.. car windows, underneath the windshield wiper. You could- you could uh.. put up neon signs, you could put up billboards, that- that was all-- nothing has really changed uh.. the, you know, I can't-- nothing comes to mind where the marketing has changed much since I've been- since I've been practicing.

Zarbock: I think there's been a substantial change in the marketing among physicians. Again, when I was a child, or in my 20s, what have you. A physician who ran an ad in anything would have been ostracized in the community in which I was living. This is not uncommon practice now.

Thomas Bruff: No it- it's not. And again, that was about the way Wilmington was when I got here in '84, is that it was- it was frowned upon. But on the- the legal aspects was, you couldn't stop this dentist. You couldn't stop this doctor from advertising however he wanted to. If he wanted to do some skywriting he could. You know, there was nothing you could on a- on a legal realm that- that would stop him. And even though the dental and the medical community frowned upon it, maybe even ostracizing that doctor or dentist to a certain extent, over the years it's just become a- a situation that uhm.. is accepted. And- and always will be.

Zarbock: That sort of leads into the question of, you're from Virginia, you went to school in Virginia, what brought you to Wilmington?

Thomas Bruff: Family. Uh.. both my parents uh.. born and raised here in Wilmington. Uhm.. I was born in Fayetteville when my father was stationed at Fort Bragg, but most of the- most all of my family here in Wilmington.

Zarbock: Okay.

Thomas Bruff: The uncle I spoke about earlier uhm.. he was a physician here in Wilmington. Uh.. again, I was a army brat, I was uh.. a military brat, where we traveled. First ten years of my life we moved five times. We went to- went to Japan, I had a sister born in Japan. We came back to Fort Campbell in Kentucky. We then went to Germany, I have two brothers born in Germany, we came back, and this was just a story of the grass was always greener. I always thought it was nice when I'd-- we'd come here to Wilmington to visit family, my mother had uh.. family had a property at- at the beach and we would stay down there at Wrightsville Beach for my dad's month of leave while he would-- and he- he'd come down there with us. We'd stay down there maybe sometimes longer then the month, but I found it v- very nice. I thought it was so cool to go to church and we're sitting in Sunday school and half the Sunday school class was related to me, I thought that was just so nice. We'd go here to Saint Paul's Lutheran Church, and half the class were either first cousins or second cousins. And I really missed that, you know, but on the other hand all my cousins thought it was really cool, you know, that I was uh.. going to Germany, and I got to see Japan. So it was kind of a grass is always greener. Coming out of dental school I had two choices, I could go back to Hampton, Virginia where I spent most- most of my uhm.. youth, had f- friends there and set up a practice in Hampton, or I could come here to Wilmington where I had family. The situation I'm in now, I- I came in with an older dentist, and- and bought him out, and- and this was my uncle- Uncle Mac's uh.. dentist. So he set me up with uh.. his dentist who was always talking about retiring. And I- I took that opportunity and uhm.. and glad of it. But I wanted my son to grow up in the atmosphere that I didn't grow up in, and that's just having-- being around family.

Zarbock: You know the economics of acquiring a practice, again without divulging the dollar amount, but how does a dentist nowadays, coming out of school, how do they get into a practice? The upfront costs could be enormous.

Thomas Bruff: The- the upfront costs uh.. usually are enormous. But as long as the dentist, as long as the dental field, as long as we have insurance, most of our patients have insurance, and as long as they are able to maintain that insurance we- we dentists are going to do very well. Because of that, there's- the uh.. opportunity to make money i- is a very uh.. real thing to the bankers. They know that if you can uh.. the- the dentist is going to eventually make some good money. And this may take three to five years is a- is about the time period of a small practice really getting on its feet, but the money is there, and- and the banks are still very, very easy to uh.. to give you the loan to either start up the practice, or to- to buy the equipment because they realize that uhm.. the money- the money potential, the earnings, are uh.. are there. W- we haven't had a- a dentist go under in Wilmington yet, although we have the largest uhm.. dentist uhm.. per capita in the state of North Carolina right here in Wilmington, everybody wants to come l- live by the ocean. But having not had a dentist go under, the banks, you just come out of dental school, you have five star credit. I- if you have any help from your family where they could- where they could help you uh.. with- with cash or with some uh.. collateral, makes it a little bit easier for you. But the money is there and- and you could- you could acquire that in any- any number of ways 'cause the banks are just very willing to lend it to you.

Zarbock: In general, and again without specifying you, but in general just give me a quick tour of the economic horizon. How much would it cost me to acquire a chair, the x-ray equipment, etcetera?

Thomas Bruff: Th- the equipment is uh.. exceptionally expensive, but it lasts forever. A- a dental chair today you can spend anywhere between 30 and-- around 20 to $30,000 just for the chair. Uhm.. 10 to $20,000 just for the x-ray unit. So to- to get into practice and- and put in a very small practice, maybe three operatories, you know, you could- you could spend on each room anywhere from around 50 to $60,000 on- on each room to fully equip it. Uh.. a lot of us don't necessarily fully equip it. Instead of putting an x-ray unit in all three ooms- rooms, to begin with, you might put the x-ray unit in one room. But uhm..

Zarbock: But then you have to have a building around those rooms.

Thomas Bruff: Yeah, I know, you know, I mean, we haven't even gone there yet. You have to acquire the building. You have to uhm.. one of the more expensive buildings to make is the dental building because of all the plumbing that's used. If-- th- the plumbing is- is such a specialty that it requires uh.. special setups. Particularly if you wanted to use nitrous oxide or have o- oxygen pumped in, the- the plumbing just uh.. elevates the cost.

Zarbock: So you can't go down to your local trailer park and say "Well give me the blue one and plug it in."

Thomas Bruff: Not really. There- there are-- you can acquire-- there are some of these little uhm.. mobile units. And some of these mobile units uh.. provide a great service get- getting out into- into the country where they are-- they don't have access to- to dentistry. But these mobile units, a lot of them- them are run on batteries. You you'll the-- a lot-- the hand pieces, the chairs, everything run on a- on a 12 volt battery.

Zarbock: Doctor Bruff, would you do it again? With the wave of a magic wand, I make you now 25 years of age, and would you go into dentistry?

Thomas Bruff: Absolutely. Absolutely. Without- without a second hesitation. If- if you enjoy-- if you have a sincere desire or if you're sincere in wanting to help people. If- if you enjoy working with people, you can do very well in dentistry. You can do very well in any of the health professions. If you have that desire to- to-- an earnest desire to want to help people. If you enjoy working with your hands, you'll do very well in dentistry. If you have the ability uh.. to-- i- if you have an imagination, and in dental school, you're- you're taught a certain way to do things, but you'll probably never see that one- that one way that you're taught, you have to adlib a lot. And through your-- the knowledge that's given to you in dental school, and- and your imagination on how things might work, what I can do in this certain situation, you'll do very well in dentistry. I- I have- I never-- prior to going to dental-- prior to coming out of dental school, I never really thought that I would make as much money as I'm making now. So I am delighted. I- I have out-performed all my uh.. I've overachieved I- I guess. I- I've done more then I ever thought that I would as far as earnings are concerned. And-- so I- I've never gotten into uh.. viewing dentistry as money. Two of the things that were said to me by uh.. Doctor Barn, the- the dentist that- that I came in with for four, five, six years and then bought him out, he said, "The day you walk into this building and put the key in the door and say 'I need to make $10,000 today,'" he said, "That's the day you need to leave dentistry." If you look at the patient, I don't- I don't-- if you were to ask me some of the cost of some of my procedures, "How much does it cost for a crown? How much does it cost for a denture?" I- I could give you a ballpark figure, but not an exact figure because I've never wanted to know. I'm gonna do the dentistry and I'll let my uh.. (clears throat) receptionist do the collections. Because once the dentist becomes uh.. in- involved with the cost of things, the patient starts to look like a dollar sign. You- if you have to- if you come in here and, "I've got to make this amount of money to make it this"- today or- or this week, you- you find yourself in trouble, because again, in life I don't care how much money you make, you're gonna spend it. So it comes down to exactly what do I need to live with. And- and what do I-- what can I get by with. Some of these young- young boys, some of these young men and young women coming out of dental school, coming out of medical school, they- they have this uh.. golden glow about them that they're going to make these millions and those millions and- and more- more times then not, they do, but it's a lot of stress that you put on yourself to perform at a certain level. If- if I make a $100,000 this year, I'm gonna h- I'm gonna have to make 120 next year, and 150 the year after that, and 200 the year after that, to increase my lifestyle. So I- I've- I- I'm delighted with dentistry. It- it's done everything for me. It has really uh.. treated me very well. I- I'm able to- to do most anything I want to do uh.. buy most anything I want to buy, and that was well above what I had really expected o- out of myself. So I- I'm delighted with dentistry and I think most people would be as long as you can maintain your feet on the ground and not get too caught up with having to have the fanciest, the best, the biggest of- of whatever you're looking at.

Zarbock: This will probably be the last topic we can get into. The demographics of the student population, when you started in dental school, what was the class size?

Thomas Bruff: Roughly a hundred.

Zarbock: How many women?

Thomas Bruff: Out of that hundred, we probably only had 15 to 16 women.

Zarbock: Currently it is my understanding, with the student population of 100, probably 50% are going to be women.

Thomas Bruff: Right now the University of North Carolina dental school is accepting more then 50% of its class, and has been doing this now for about the last five years or more, uh.. women.

Zarbock: What comments would you care to make about that?

Thomas Bruff: Well you really, in the dental/medical field, you really open a can of worms when you start talking about women coming into dentistry, I-- or- or medicine for that matter. I think particularly dentistry is one of the best jobs a woman could possibly have. Most of the female dentists that I know, that they came into dentistry wanting to do a job, generate some income, yet raise the family. And boy, in dentistry you can do that. You can come in with an established dentist, work as many days as you want, generate some great income, but still have the time that you can spend at home. When the established dentist is looking for an associate, when you bring the man in, when you bring the male dentist in, eventually he wants to own that practice. Now you bring the female in and she's not necessarily, although we have some great female dentists here in Wilmington that are uh.. sole proprietors, they own their own business, the majority of them, again, instead of wanting to necessarily own the practice are very happy being an associate, maybe for their entire career, so they can balance the family and provide a- a service. But uh.. on the other hand, we- we get into discussions that if we're going to bring the- the female into the profession, what's the percentage of- of the- of the women who don't practice. They may practice a year or two and then commit themselves exclusively to the family, and we've lost that uhm.. worker o- on the frontlines of dentistry. So i- it's great for- it's for the women, but the- the big uh.. discussion is whether or not it's feasible to count on- on the female to work the 20, 30, 40 and in some cases 50 years that- that some of the men do. Uh.. we're very reluctant to discuss that, you know, with the women dentists, the female dentists 'cause they- they don't necessarily uh.. look at it that way, but that's something that the uhm.. the- the male dentist or male doctor uh.. also looks at, that the female is more likely not to practice compared to the male, but to get out into the uh.. into the public and provide a service the- the female does that as well as the male, and that's for sure, and- and I- I believe that's probably why that most dental schools now are accepting more women then they did when I came out of dental school.

Zarbock: Doctor Bruff, this has been a dandy interview, and I appreciate the time.

Thomas Bruff: Thanks.

Zarbock: Have a good day sir, and thank you again.

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