Dentist Rancho Cucamonga

COVID-19 Vaccination

I think many will agree that so far the greatest thing about 2021 is that it puts 2020 behind us. We have all endured and have been trying to overcome a multitude of hardships from 2020 – from protests, to wildfires, earthquakes to of course COVID-19. While we started off 2021 with a historic riot, I think with the advent of the COVID-19 vaccine, there is hope that we may reach the end of the tunnel of our pandemic through herd immunity. Many patients have asked if we plan on being some of the first to take one of the U.S. made vaccines … and if so which one?

I’m pleasantly optimistic to say that as of 1/14/21, I have been inoculated with my first dose of the Moderna vaccine. The process was relatively straight forward. I registered for a drive through location, arrived a few minutes early and waited in line in my car. Once I presented my credentials, they asked a few questions and I was given the jab. I was then instructed to park near some medical staff for observation for 15 minutes and released once I reported no side effects.

Day 1 of Moderna Vaccine 1/14/2021: Very mild soreness in my left arm near injection site.

Day 2 of Moderna Vaccine 1/15/2021: Increase to medium/mild soreness in my left arm near injection site.

Day 3 of Moderna Vaccine 1/16/2021: Down to very mild soreness in my left arm near injection site.

Day 4 of Moderna Vaccine 1/17/2021: I have grown a third arm! My left arm feels fine.

While I believe all the vaccines for COVID-19 will help us overcome this pandemic, many ask why did I choose Moderna vs Pfizier? Below were my reasons as of 1/17/2021:

Moderna’s efficacy rating after the 2nd dose was at 94.1%. While it’s lower than the 95% from Pfizier – one has to remember Pfizier originally published a rate of 90% and then after a few days of Moderna publishing their rate of 94.1%, Pfizier miraculously raised their efficacy of the 2nd dose to 95%…

Moderna’s efficacy after the first dose is between 80-90% efficacy; Pfizier is between 50-60%.

Moderna’s vaccine is stable for up to 30 days in a regular refrigerator or 12 hours room temperature and is ready to dose without dilution; Pfizier is stable for 5 days or 2 hours room temperature and needs to be diluted with sterile 0.9% Sodium Chloride Injection.

Moderna’s side effects per FDA:

  • Injection site pain
  • Fatigue
  • Headache
  • Muscle pain
  • Joint pain
  • Chills
  • Swollen lymph nodes

Pfzier’s side effects per FDA:

  • Injection site pain
  • Tiredness
  • Headache
  • Muscle pain
  • Chills
  • Joint pain
  • Fever
  • Injection site swelling
  • Injection site redness
  • Nausea
  • Feeling unwell
  • Swollen lymph nodes

Some people ask why not wait for AstraZeneca-Oxford vaccine? I have more trust in US made health care products and more importantly the efficacy of AstraZeneca-Oxford is at 70.4% – which is quite a drop to 94.1-95%. For my safety and the safety of my patients and family, I would prefer to go for a better efficacy. However please note that 70.4% is still far superior than our annual flu vaccine, which per the CDC is around 40-60%. Although there are no numbers out yet, Johnson & Johnson (another US based company) will soon be out with their own vaccine. The preliminary information reports that this will be a single dose vaccine (vs 2 dose system of Modena/Pfizier) – making it faster to inoculate the United States. Unfortunately, the data on their stage 3 trials are not out and so final efficacy is still in question. IMHO, please stay with a US made vaccine because all their testing data is open to the public and reviewed by an independent panel. In addition, they are better tested, safer and as of now, offer a higher efficacy:

UK:  AstraZeneca-Oxford (Reviewed by independent panel, data is open to public)- 70.4% Efficacy

China:  Sinovac (1st reviewed by unknown person(s). Second reviewed by Brazil. Data is closed to the public)– started at 78% and now down to 50.38% Efficacy

China: Sinopharm – (Reviewed by unknown person(s). Data is closed to the public) started at 86% and now down to 79.34% Efficacy

Russia: Sputnik V-9 (Self reviewed. Data is closed to the public) started at 95% then went 91.4%, as of January 2021 it’s now down to 73-85% Efficacy

Hanna Hsu Update

Many friends and patients have asked about updates to my daughter and her congenital heart defect. The memories of those long, grueling and depressing nights at Children’s Hospital Los Angeles (CHLA) have seared a permanent scar in my life and it’s not something I enjoy reliving. However for the sake of closure, I will try and summarize those traumatic events rather quickly…. We will begin during the time after Hanna’s first successful open heart surgery (Blalock shunt procedure) – performed when she was around 9 days old …

The months that we spent their holding Hanna’s little hands and hoping for the day that we could take her home seemed endless. It’s interesting how we take the simplest things in life for granted. I remember watching other babies effortlessly drink a bottle of milk on their own, in one feeding and contemplating how lucky they were …. we were struggling just to get Hanna to drink 1-2 milliliters (mls) of fluid using a pipette. During those harrowing nights in the hospital, our ears would be engulfed with the sounds of multiple alarms going off every few minutes as a result of other infants on the floor losing oxygen too rapidly or with the perpetual screams of pain after having their chest bones cracked open during open heart surgery. Sometimes my wife or I would get up from our area and try and comfort the other babies … but honestly how to console an infant who only weighs 5-10 lbs, has a fractured sternum with multiple stitches down a 5-7 inch incision, tubes protruding out of their nose, arms and legs and suffocating from hypoexima (from not being able to supply enough oxygen to your brain because of a defective heart)? Then on those rare, dreadful occasions, we would hear a different alarm go off across the floor, followed by an emergency code announced over the speaker and finally accompanied with the sounds of hurried footsteps as a wave of nurses and doctors rushed to an ominously silent infant. Those horrible nights seem to last an eternity in the hospital … nights went into days and then into weeks and ultimately into months. Even when we were finally ready to bring her home, Hanna had to be monitored carefully – not to have her cry for too long or her lips and face would turn blue or not to over tax her body from the exhaustion of trying to drink 10-15 mls of milk. All the while my wife or I would be prepared to administer emergency infant CPR should her her heart fail. Thankfully gone are the days of having to strap a pulse oximeter monitor on her little fingers with alarms and oxygen tanks stored near her baby crib.

Hanna would eventually need a second open heart surgery at around 6 months old – which we had to push to get modified. My wife had forwarded her case to Best Doctors for review. They then sent her file to Dr. Nido over at Boston Children’s Hospital. (Many experts consider him the top pediatric cardiovascular surgeon in the world). He had recommended that we do decompression of the hypoplastic right ventricle during the Glenn surgery – in the hopes that we stimulate growth of her right ventricle therefore avoiding a third open heart surgery. After review of the recommendations, CHLA and Dr. Starnes (another one of the world renown pediatric cardiovascular surgeons) agreed to proceed with this modification given that there was little additional risk and it would give Hanna a chance to improve her heart condition. Fortunately, the surgery went well, and our baby girl only needed a few weeks of recovery at the hospital (vs the few months after her first surgery).

Hanna Hsu 2020

Fast forward to today (11 years later). Hanna is doing well. She still has her bi-annual cardiovascular check-ups. So far, she has avoided the need for any other surgeries, and we hope that the surgery modification that they had performed during the Glenn, may perhaps set precedent in helping other children with similar defects. While her blood oxygen level is still not comparable to that of a healthy person, she is for the most part healthy and has grown into a bright and beautiful girl.

Due to her heart condition, Hanna’s physical endurance is a lot lower than those of her peers. However, she has found enjoyment in other non-physical activities, such as reading and writing. Recently we are proud to announce that she won first place in the Clear Water TBM Naming Contest:

https://clearwater.lacsd.org/schoolContestResults.asp

i-CAT FLX 3D Cone Beam Computed Tomography (CBCT) system

Many of my colleagues were surprised to hear that I was considering upgrading to the newest state of the art CT scanner after only 5 years of having one of the most advanced 3D systems in the market- the Rayscan from Samsung. To this day none of them have a CBCT in their office. In fact many surveys show that only a fraction of dentists have these advanced machines in their office. Because of the many referrals we get from PCPs, ENT’s and Pulomonolgists, I needed to ensure that our practice had the latest technological advancement in CBCTs designed for flexibility in scanning, imaging and treatment planning. We also wanted to provide improved clarity at a lower radiation exposure to the patient.

Radiologists and CBCT manufacturers know that the award winning i-CAT FLX technology is regarded as the cone beam industry standard. In addition, the i-CAT would allow more detail with less radiation – a scan has a dose equivalent to the average radiation exposed to a person going about their “normal” life in the USA for a few days. However, being the best when it comes to CBCT technology comes with a high cost and we had just paid off our 5-year financing for the Rayscan… Yet I strongly believe that limiting the radiation exposure each patient receives, while giving us the best imaging quality would make this investment well worth it.

Hence in late February of 2020 we upgraded to the i-CAT FLX and the consensus from our staff and patients have been positively enthusiastic. One of our goals at our group practice is to have the most state-of-the-art, accurate technology to assist in diagnosis and treatment of our patients. We feel the i-CAT will allow us to continue our excellent standard of care in achieving success for our patients.

Zeiss Dental Microscope

As a leading dental group practice, we always strive for the best quality of care using the most innovative technology for our dental and medical care. In order to better accommodate many of our patients, we started to incorporate advanced endodontics (Complex Root Canal Treatment) in our office. We researched for various types of dental microscopes to improve our quality of care. One brand stood out above the rest: Zeiss, an internationally technology leader operating in the fields of optics and optoelectronics. Since it’s formation in 1846 in Germany, Zeiss has transformed into a large, research-oriented company that distributes a host of optical products across the world and is well known by almost every surgeon as the best of the best when it comes to optical accuracy. Early in 2019 we decided to add the Zeiss dental microscope to our office to join our growing list of advanced technology.

3Shape TRIOS

For over a century, we as dentists have used various different materials to take molds (impressions) of the hard and soft tissue in the oral cavity. Many patients had no choice but to put up with it, while others suffered through gagging or left with a snack – otherwise known as extra dental fluff in their mouth. Advances in dental technology came out with other ways of doing these impressions digitally- one of the first was Sirona CEREC. Some brave dentists immediately jumped on board thinking it was the greatest thing since sliced bread. These advanced machines were used to create dental restorations, such as crowns without the use of that dental “GOOP” abhorred by so many patients. I held back during that time, because I did not want to be the first to experiment with this technology without seeing a reliable track record. Not long after, a major flaw was soon discovered…These machines were not as accurate as the dental “GOOP” or standard PVS impression material, causing many patients to return to those dental offices with inadequate dental restorations, such as leaky margins or recurrent decay. Years passed by and the technology gradually improved to the point where certain companies were able to dramatically improve the accuracy. The American Dental Association recently published an unbiased study showing the following:

I realized why so many patient’s complained about having problems with other dental offices who do “Same Day Crowns” by Sirona CEREC in their own office. These Sirona CEREC machines used to take digital impressions and mill dental restorations such as crowns were faulty because their accuracy were the worst out of the six main intraoral scanners on the market. The accuracy of CEREC is even worse than than the best dental “GOOP” PVS impression, which has an accuracy of 10-20 µm (microns). After review of the ADA literature, obviously one digital scanner stood out: 3Shape TRIOS. Not one wanting to base my knowledge on just one study, I dived deeper and found that study after study the 3Shape always came out on top. A few months later, we purchased the 3Shape TRIOS Cart in August of 2017 and many patients were ecstatic. Having the most advanced/accurate digital scanner in the world, we try and use it for most of our dental and medical procedures today. However there are times when we have to go back to the standard dental “GOOP” material because of difficulty accessing the area and or distortions due to contaminants such as oral debris and bodily fluids.

 

Give Kids A Smile ADA Foundation

Sunday, February 26, 2017

On Friday 2/24/2017 I volunteered for the ADA Give Kids a Smile Program at a preschool in Monrovia. Unfortunately I was the only non-staff volunteer dentist to participate. I know for a fact that they were doing mass emails to find other dentists to volunteer – I just feel an indescribable sadness because I was the only person to respond …

We provided oral examinations, oral hygiene instructions, and gift bags for over 72 kids from the ages of 2-5 years old. What I found interesting was that although a few number of kids needed proper oral hygiene instructions, I found no children with existing carious lesions. It was a far cry from 1999-2000 when I was volunteering at the USC Mobile Clinic; back then with those kids over 75% were in need of immediate dental work. Monrovia was obviously a much more affluent area than the cities that we visited with the USC Mobile Clinic. It’s days like these that remind me the stark differences in oral health between the impoverished areas and the more economically developed cities. While some of the reasons are a result of access to care, I believe the majority are the results of financial constraints.

In Memory of Dr. William Wei Hsu

February 3rd, 2017

Last night at around 8:00 pm, I sat at my desk in my group practice, looking at a pile of about 50 patient charts that I needed to finish up. I was thinking, how in the world was a going to write the closing eulogy for my dad’s funeral, taking place tomorrow? My thoughts were interrupted with the beeping of my cell phone. I looked down on my screen and saw that my sister, Serena, had sent me a text with a copy of her speech. My sister has always been the better writer in our family. Seeing how incredible her eulogy was made me feel proud, but at the same time, it made me apprehensive because I knew I would have to follow. Then as I scrolled further down my phone, I saw that Serena was trying to help me, by writing a rough draft of my closing eulogy. If  Dad was with me last night; I could already imagine the look on his face – frowning down at me for trying to find the easy way out. That thought was all the encouragement I needed to throw out my sister’s draft and get to work.

Today, this morning on the day of the funeral, I was contemplating about what to say, while driving in the rain to a job site to pump and work on a feasibility plan to re-route or replace some septic tanks. It was ironic because when I was a kid, I remember my dad telling me, “You better work hard or you’ll be a garbage man.” I hope Dad would not be disappointed that this was one of those rare times that I proved him wrong. I was indeed working very hard … on preparing to oversee and design the septic system for a house. However technically since I was still working with sewage and garbage, I guess I could be misconstrued as a doctor who on his off days worked as a “garbage man.”

My dad’s relationship with me was not one of many words– he didn’t have to say a whole lot to get me going, just a simple look maybe a short statement and that would be enough. My father was a great man backed by an overwhelming number of accomplishments and yet he refused to accept his own greatness. To this day, I still remember the time he was helping me with my High School AP Physics class homework. He had come back from work late at night, had a small dinner and at around 11:00 PM, he was trying to teach me how to go about solving a complicated physics problem, without actually doing the work for me.  I was frustrated and said something to the effect of, “I can’t do it on my own, I’m not smart like you.” There was an immediate pause as my dad lowered his head ever so slightly, looked directly up at me. Letting his glasses slide just barely down the bridge of his nose, he used those stern eyes to erase my last words. He then told me that he was not a very smart man, that he had above average intelligence and that he was only able to get by in life because he worked hard. As he said those very words, I looked up at the wall to see his PHD, various Masters degrees and other accolades. My dad had so many awards and patents that there was literally a pile of  plaques stacked  next to him because there was not enough wall space to hang everything.  I think my dad was right; he was not a “smart man” … he was a genius.

In regards to that physics homework that he helped me with; well a problem similar to that appeared later when I attended college. I was sleeping and snoring obnoxiously loud in a chair during one my physics lecture at USC. This particular physics professor had a habit of embarrassing disruptive students. So he threw an eraser at me, to wake me up. The professor then told me to come up to the front and solve a difficult question on the board. So I got up, strode confidently to the front of the class and in my head I thanked my dad. I took that marker and with no hesitation, I  solved that physics problem with ease. Afterwards, as I went to sit back down, most of the class went silent with astonishment – except of course for my friends, who were laughing and trying to high five me – they said something like, “Holy [blank], you are one smart [blank].” I just shook my head in denial and said, “I’m not smart, I just had a genius teacher.”

Fast forward to only a few weeks ago. I still remember when Dad was laying in his bed, fighting against all his ailments with more strength and courage than I could ever imagine. That day his mantra of telling me to work hard had changed. While by his bed side, he told me to not work as hard as him because life was short. Behind that simple statement, I knew he meant that he wished he could have spent more time with us as family, instead of always being out all day, working so hard to provide for us. In his final days at the hospital, the doctors were amazed that even though Dad looked deceivingly frail, he was incredibly strong and continued to fight, working hard for every breath … until the very end.

Dad would be extremely uncomfortable with all of us sharing these remarkable things about him. So, as we say goodbye to him, please remember the things we love so much about Dad. I know in his afterlife, he would be standing there with that great big smile and he would be so proud to see all the people here, who loved and admired him. I love you, Dad, and I’ll miss you more than any words can say.

Xie  xie  Fa Shi  min,  Hui Zhang  Shao Yifu,  Xiao Ai Yi,

gen  Jin Zhong Shehui  da  hui renmen.

Xie xie dajai bang mang , hai you suoyou da qin qi gen pengyou. Xie Xie nimen lai.

On behalf of my family, I would like to thank everyone for being here today. We appreciate the Buddhist monks, the Amida Society president Uncle Jason Chen and Aunt BT Chen, Amida Society members, our relatives, and friends for spending the time to come out to honor our Dad. Burial services will be held this afternoon after 2:30 PM in my family’s burial grounds, at the Gardens of Contemplation. Thank you again.

3D Cone Beam CT Technology

Sunday, November 15, 2015

Recent advances in technology has allowed many dentists to apply 3D Cone Beam CT imaging to patient care in private practice. I took the plunge late in 2014, investing in one of the top rated 3D Cone Beam CT scanners in order to improve the quality of dental care for my patients. While most hospitals will charge around $1000 for a single scan, we charge only a small fraction of that cost. Less than one percent of the dentists in the world have this technology – in fact none of my current fellow cosmetic and general dental colleagues in my known network have one of these machines (as of November 2015). I’m sure most dentists may think it highly impractical to allocate such a large monetary sum towards technology that will not give an immediate return on investment. However in my humble opinion, the peace of mind that I am providing the best dental care for all my patients outweighs any monetary reward.

I have been very impressed with the accuracy of our imaging technology thus far. Below is a sample case of one of the methods of how we utilize our 3D Cone Beam CT in our practice. In these images we are maximizing both the length and diameter of each implant, thereby improving the retention and therefore the longevity of the implant.  Please note the close proximity to the IA and mental nerve. Without  this technology, many dentists may run the risk of damaging a nerve when placing implants of this size.


In February 2015, Dental Products Reports, one of the nation’s leading dental magazines interviewed our office to discuss our thoughts on this technology. More information can be found at

A copy of the article published in Dental Products Reports can be found below:

Giving back to the Volunteers

On April 27th, 2014, I had the rare chance to volunteer at a free dental clinic serving the volunteers that help run some of the medical/dental free outreach clinics. It’s rare when we receive the opportunity to help those that help others…I think we as humans get so involved with the donation of funds and services to others in need that we forget about helping those people who make it possible for us to do so. This was the very first free clinic geared towards helping the actual volunteers. To no surprise the oral health conditions of our fellow volunteers were excellent. The only services that I preformed that day were exams and cleanings. Nonetheless it felt great being able to give back to those who give…

Donations & Free Clinic in Orange County

Monday, August 26, 2013

After finally moving into our new facility, I compiled an inventory of dental supplies and equipment that I no longer needed. Estimated net worth of these items based off of comparative sales equates to over $4500.00. Once we were settled into our new office, I contacted Loma Linda School of Dentistry and arranged for a pick-up for my donation. For those other dentists, who do not realize, Loma Linda has international outreach missions of free clinics that are in dire need of dental equipment and supplies. Loma Linda runs these missions through NASDAD (National Association of Seventh-day Adventist Dentists) Should anyone wish to send in a donation please contact them at:  909-558-8187

The following month I was contacted by the director of the Tzu Chi Medical Foundation  about their very first free medical and dental clinic in Orange County. This organization has been operating various mobile clinics throughout Southern California and Mexico for over a decade. I immediately made arrangements so that I would be able to volunteer and donate my services.

Upon arrival on 8/25/2013 in Santa Ana, I noticed that while there were a lot of patients in the waiting area, the numbers were not anywhere near what I am used to experiencing in the free clinics in San Bernardino and Mexico. Perhaps the population in Orange County were not as financially strapped and therefore did not need as many of these free services? I was immediately ushered into the mobile unit and assigned to perform surgical extractions and fillings.

What I felt was nice, was that they assigned 1-2 assistants to help me with my dental surgeries. Normally the doctors at free clinics receive 0 – 1 assistants – so this was a pleasant surprise. These assistants were also volunteers – the lady in the photo is a retired molecular biologist, while the gentleman was an engineer. Because this was Tzu Chi’s  very first free clinic in Orange County, it took the organization almost an hour before we were able to see patients. Therefore we started around 10 am and ended at 2:30 pm. Even though the duration of this free clinic was shortened, I was still able to see about 12 patients, all with procedures such as scaling and root planning, fillings and surgical extractions. In general, I did notice that the oral health of patients here in Santa Ana were definitely in better condition than that of the patients in the San Bernardino and LA counties. However regardless of the conditions of their teeth, all these patients were in need of dental work, and all of them were very grateful that we provided them with our services.

Posted by Dr. Brien Hsu at 1:04 PM

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